When to Stop CPR

Why is this Important? * It is a poor stewardship of resources to continue a resuscitation when the prognosis is clearly dismal. * Hospitals need to steward their resources to distribute equitable care between its patients When is it Appropriate to Stop CPR on a Pulseless Patient? * Patient shows signs of irreversible death* Rigor mortis* Decapitation* Rotting/decaying* Patient has dismal prognosis (3 studies discuss this)* Implementation of the universal BLS termination of resuscitation rule in a rural EMS system* Non-EMS witnessed arrest* No return of spontaneous circulation prior to transport* Only non-shockable rhythms present* Early identification of patients with out-of-hospital cardiac arrest with no chance of survival and consideration for organ donation* Non-EM witnessed arrest* Non-shockable INITIAL rhythm* No ROSC despite 3 doses of epinepherine* Duration of pre-hospital CPR and favorable neurologic outcomes for pediatric out-of-hospital cardiac arrests. A nationwide, population based cohort study* Less than 1% chance of recovery after 46 minutes of resuscitation Additional Reading * Jordan MR, O’keefe MF, Weiss D, Cubberley CW, Maclean CD, Wolfson DL. Implementation of the universal BLS termination of resuscitation rule in a rural EMS system. Resuscitation. 2017;118:75-81.* Jabre P, Bougouin W, Dumas F, et al. Early Identification of Patients With Out-of-Hospital Cardiac Arrest With No Chance of Survival and Consideration for Organ Donation. Ann Intern Med. 2016;165(11):770-778.* Goto Y, Funada A, Goto Y. Duration of Prehospital Cardiopulmonary Resuscitation and Favorable Neurological Outcomes for Pediatric Out-of-Hospital Cardiac Arrests: A Nationwide, Population-Based Cohort Study. Circulation. 2016;134(25):2046-2059.