Termination of resuscitation is the decision to stop CPR in the field when further efforts are very unlikely to help. EMS uses validated rules and online medical direction, then turns its care to the family and the scene.
Key symptoms
- Arrest not witnessed by EMS
- No return of spontaneous circulation before transport
- No shock delivered (BLS rule)
- Ongoing asystole despite full ALS care
- Obvious signs of death: rigor mortis, lividity, injuries incompatible with life
What you find on exam
- Rhythm on the monitor; confirm asystole in two leads
- End-tidal CO2 below 10 mmHg after 20 minutes of high-quality CPR
- Pupils and pulse checks
- A valid do-not-resuscitate order or POLST form
- Scene safety and a possible crime scene
Tests
- Termination of resuscitation rule checklist
- Trend of waveform capnography
- Point-of-care ultrasound, if trained, to show no cardiac activity
- Consultation with medical direction
Treatment basics
- Give at least 20 minutes of high-quality CPR and ALS care before deciding
- Consult medical direction per protocol
- Stop CPR and record the time of death
- Support the family, explain in clear words and offer resources
- Leave tubes and lines in place for a medical examiner case; complete the documentation
Red flags
- Hypothermia or cold water drowning: keep resuscitating
- Return of a pulse, a shockable rhythm or rising end-tidal CO2
- Family or scene becoming unsafe
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; AHA Guidelines for CPR and ECC; NREMT psychomotor skill sheets (EMT and Paramedic). Written by Making Synapses. Making Synapses is not affiliated with these organizations.