From the Guidelines
There is no specific number of rounds of CPR that must be performed before declaring a patient dead, and the decision to terminate resuscitation efforts should be based on multiple factors, including the cause of arrest, response to interventions, duration of resuscitation, patient comorbidities, and the presence of reversible causes. The American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care in 2015 emphasizes the importance of high-quality CPR, with a goal of optimizing all measures of CPR quality, including adequate compression rate and depth, allowing full chest recoil after each compression, minimizing interruptions in chest compressions, and avoiding excessive ventilation 1.
Key Considerations for CPR
- The decision to terminate resuscitation efforts depends on multiple factors, including the cause of arrest, response to interventions, duration of resuscitation, patient comorbidities, and the presence of reversible causes.
- Resuscitation efforts should continue for at least 20-30 minutes in adults if there is no return of spontaneous circulation (ROSC) 1.
- High-quality CPR should be maintained with minimal interruptions, while addressing potentially reversible causes such as hypoxia, hypovolemia, hypothermia, electrolyte abnormalities, toxins, cardiac tamponade, tension pneumothorax, and thrombosis.
- Advanced cardiac life support (ACLS) protocols should be followed, including appropriate medication administration (epinephrine 1mg IV every 3-5 minutes, amiodarone for shockable rhythms) and defibrillation when indicated.
Clinical Judgment and Decision-Making
The decision to terminate resuscitation ultimately requires clinical judgment by the healthcare provider leading the resuscitation, considering the overall clinical context and likelihood of successful resuscitation. In some cases, such as hypothermia, drug overdoses, or special circumstances, prolonged resuscitation efforts may be warranted. The importance of high-quality CPR and the need for clinical judgment in decision-making are emphasized in the 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations 1.
From the Research
Number of Rounds of CPR
The number of rounds of cardiopulmonary resuscitation (CPR) to be performed before declaring a patient dead is a critical aspect of medical decision-making. According to the study by the National Association of EMS Physicians Standards and Clinical Practice Committee 2, a full resuscitative effort, including CPR, should be performed for at least 20 minutes following Advanced Cardiac Life Support (ACLS) guidelines before declaring the patient dead.
Factors Influencing Termination of Resuscitation
Several factors should be considered when deciding to terminate resuscitation efforts, including:
- The patient's initial cardiac arrest rhythm and response to treatment
- The duration of CPR and defibrillation attempts
- The presence of underlying medical conditions or trauma
- The patient's age and overall health status
- The availability of medical resources and personnel
Duration of Prehospital Resuscitation Efforts
A study published in the journal Circulation 3 found that prehospital resuscitation efforts should be continued for at least 40 minutes in adults with bystander-witnessed out-of-hospital cardiac arrest. This duration may vary depending on the patient's initial cardiac arrest rhythm and response to treatment.
Implications for Out-of-Hospital Care
The existence of CPR-only survivors of out-of-hospital cardiac arrest highlights the importance of continued resuscitation efforts in the prehospital setting 4. However, the decision to terminate resuscitation efforts should be made on a case-by-case basis, taking into account the patient's individual circumstances and medical history.
Cerebral Resuscitation Research
Research initiatives focused on cerebral resuscitation after cardiac arrest aim to improve survival rates and minimize brain damage 5. While significant progress has been made, further studies are needed to develop effective treatments and strategies for optimizing CPR performance and minimizing response times.