termination of cardiopulmonary resuscitation (CPR)

^[1]^[2]^[3]^[4]

Indications

25-30 minutes from the start of a witnessed cardiac arrest
10 minutes of documented asystole after appropriate implementation of ACLS protocols
better outcomes with 25 minutes (mean) of resuscitation vs 16 minutes (mean)^[3]
Universal Termination of Resuscitation
- resuscitation should be terminated by emergency medical services (EMS) if, after at least 4 2-minute intervals of cardiopulmonary resuscitation, 3 criteria are met:
  - the arrest was not witnessed by EMS
  - there has been no return of spontaneous circulation
  - no shocks were delivered

↑ ACLS - The Reference Texbook ACLS: Principles & Practice, Cummins RO et al (eds), American Heart Association, 2003 ISBN 0-87493-341-2
↑ Wampler DA et al. Cardiac arrest survival is rare without prehospital return of spontaneous circulation. Prehosp Emerg Care 2012 Jul 26 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22834854 <Internet> http://informahealthcare.com/doi/abs/10.3109/10903127.2012.695435
↑ ^3.0 ^3.1 Goldberger ZD et al Duration of resuscitation efforts and survival after in-hospital cardiac arrest: an observational study The Lancet, Early Online Publication, 5 September 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22958912 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60862-9/fulltext
Nolan JP and Soar J Duration of in-hospital resuscitation: when to call time? The Lancet, Early Online Publication, 5 September 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22958913 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61182-9/fulltext
↑ Jordan MR, O'Keefe MF, Weiss D et al. Implementation of the universal BLS termination of resuscitation rule in a rural EMS system. Resuscitation. 2017 Jul 13;118:75-81 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28713042 <Internet> http://www.resuscitationjournal.com/article/S0300-9572(17)30285-X/fulltext