Knowing When to Stop CPR: A Critical Decision

Performing cardiopulmonary resuscitation (CPR) is a vital skill that can save lives during cardiac arrest. As a lay-rescuer or good samaritan bystander, your duty is to continue CPR until emergency help arrives. For the EMT, EMS, Paramedic or medical provider, however, there comes a point when continuing CPR may no longer be beneficial. Here are essential considerations for knowing when to stop:

Time and Survival:

• 20-Minute Rule: After at least 20 minutes of CPR without return of spontaneous circulation (ROSC) or a viable cardiac rhythm, it's generally appropriate to consider stopping.
• Asystole: If the initial rhythm is asystole (flatline) and persists for 20 minutes, survival chances are minimal.

3. In-Hospital Measures:

• Consider reversible factors (4Hs and 4Ts).
• Monitor ETCO2 levels (persistently low values after 20 minutes have poor outcomes).
• Bedside echo findings (some patients experience ROSC despite no visible cardiac activity).

4. When to Cease CPR:

When a person shows any signs of life, you should cease CPR and assess the patient. Have all the necessary information ready for when emergency responders arrive, and keep pumping until they give the okay to stop if the person is not breathing or moving. They may have equipment to set up and need you to continue performing CPR until they are ready to take over. As an advanced medical provider, the following are some instances where CPR may be ceased by ALS or BLS personnel:

• When a patient has, in their possession, a Do Not Resuscitate Order (DNR).
• There is no return of spontaneous circulation (ROSC)
• Resuscitation efforts have been transferred to a person(s) of no less skill than the initial providers.
• Rescuers are exhausted and physically unable to continue resuscitation.
• The online medical control physician advises the termination of resuscitation.

When NOT to Stop CPR

Prolonged resuscitation is typically required in these instances:

• Continue as long as VF persists
• Hypothermia
• Asthma
• Toxicological arrest
• Thrombolytics given during CPR (continue up to 2 hours post-administration)
• Pregnancy prior to resuscitative c-section

Remember, the decision to stop CPR is complex and should involve clinical judgment. Always consult with medical professionals or emergency responders when possible. 🚑🌟

Sources:

• EMS Termination Of Resuscitation And Pronouncement of Death - National Library of Medicine
• CEASE: A Guide for Clinicians on How to Stop Resuscitation Efforts - ATS Journals
• Asystole - Cleveland Clinic