Discontinuation of 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 after the delivery of appropriate ALS resuscitative efforts.
- 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
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.
- 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:
- personal physician
- Medical Control
- 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.