Discontinuation of Prehospital Resuscitation




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




  • To allow for discontinuation of pre-hospital resuscitation efforts in patients in cardiac arrest.





1. Discontinuation of CPR and ALS intervention for non-traumatic cardiac arrest patient may be implemented without Online Medical Control authorization in the following patients:


2. Patient is 18 years of age or older.


3. High quality CPR has been performed.


4. Airway management with confirmed effective ventilations. Acceptable airway management techniques include blind insertion airway device (IGEL or King LT), orotracheal intubation, nasotracheal intubation.


5. Waveform Capnography has been initiated, observed, and trended throughout management of arrest.


6. IV or IO access achieved with rhythm appropriate medications administered.


7. All providers involved in the patient’s care agree that discontinuation is appropriate.




  • An EMS witnessed arrest.
  • Return of Spontaneous Circulation (ROSC) or presumed ROSC at any point in care.
  • CPR induced consciousness at any point in care.
  • Abrupt rise in EtCO2 ≥ 10mmHg ± pulses.
  • Hypothermic patients.
  • Pregnancy.
  • Resuscitation attempted within public view.




  • Persistent VF/VT (after 3 or more defibrillations)
    • Do not perform Termination of Resuscitation, initiate transport.
  • Asystole or PEA
    • if EtCO2 < 10mmHg, consider termination after 20 minutes.
    • If EtCO2 ≥ 10mmHg, consider termination of resuscitation after 30 minutes.
    • Times begin when chest compressions are started by a credentialed fire or EMS provider.



  • Consider differential diagnosis of arrest and potential benefit of ED intervention, particularly in younger otherwise healthy patients.
  • If resuscitation is performed in a public setting or one felt to be inappropriate to terminate, work the arrest until the patient can be transferred to ambulance. Continue resuscitative efforts enroute to nearest appropriate emergency department. Consider contacting online medical control for field termination orders if appropriate.
  • Traumatic arrests can be terminated on-scene without contacting Medical Control if at any point the patient presents with asystole or a wide complex PEA less than 30.
  • Refer to Death Communication with Family Policy early in resuscitative process.
  • Refer to Deceased Persons policy following termination or resuscitation.