Discontinuation of Resuscitation

 

Policy:

 

  • Unsuccessful resuscitative efforts may be discontinued prior to transport or arrival at the hospital when this policy is followed.

 

Purpose:

 

  • To allow for discontinuation of pre-hospital resuscitation after the delivery of appropriate ALS resuscitative efforts.

 

Procedure:

 

  • Discontinuation of CPR and ALS intervention for a medical cardiac arrest patient may be implemented prior to contact with Medical Control if ALL of the following criteria have been met:

 

    • Patient is 18 years of age or older.
    • Adequate CPR has been administered.
    • Airway has been successfully managed with verification by
      • bilateral lung sounds
      • absence of epigastric sounds
      • capnography
    • Acceptable management techniques include
      • oral tracheal intubation
      • nasotracheal intubation
      • blind insertion airway device such as the KING LT.
    • IV or IO access has been achieved.
    • Rhythm appropriate medications and defibrillation have been administered according to protocol
    • Persistent asystole (6 seconds in two leads) is present
      • no reversible causes are identified
      • minimum of 25 minutes of resuscitation or
      • PEA with EtCO2 less than or equal to 10 after 25 minutes of resuscitation.
    • Failure to establish sustained palpable pulses
      •  persistent/recurring ventricular fibrillation/tachycardia
    •  or any continued neurological activity such as eye opening or motor responses.
    • Non-reactive pupils.
    • No evidence of hypothermia.
    • All EMS Paramedic personnel involved in the patient’s care agree that discontinuation of the resuscitation is appropriate.
    • The patient is in a residence (non-public place) and the scene is safe to do so.
  • If not all of the above criteria are met and discontinuation of prehospital resuscitation is deemed appropriate, contact Medical Control.
  • If the patient is in a public place or the scene is deemed unsafe to terminate resuscitation; work the arrest until the patient can be transferred to the ambulance. Continue resuscitation efforts, transport to the closest appropriate emergency room, and contact Medical Control for possible termination orders.
  • Traumatic arrests can be terminated on-scene without contacting Medical Control if at any point the patient presents with
    • asystole or
    • wide complex PEA less than 30.
  • Document all patient care and interactions in the patient care report (PCR) with the individuals:
    • patient’s family
    • personal physician
    • Medical Control
    • Coroner
    • law enforcement
  • Involve the family early in the resuscitation process:
  • Provide reassurance that everything possible is being done
  • Ease the family into the decision to terminate resuscitation
  • Provide emotional support
  • Contact the Coroner's office early on patients under the age of 60 without a significant medical history.
  • If a possible Coroner case, involve family in discontinuation, but do not allow them to disturb the patient or the surroundings.
  • If the Coroner's office releases the body, make the patient presentable by removing IV's and airway devices and covering the patient.
  • Do not remove any devices prior to contacting the Coroner's office.
  • Whenever possible, terminate resuscitation prior to transport and follow the same procedures as if the patient was found dead on-scene.
  • Follow the Deceased Persons Protocol.