#tables #OSCE see: [Cameron - Stopping resuscitation](x-devonthink-item://D6D8BC2E-B2A6-46F5-9F6C-DA3859973088?page=27&start=5453&length=22&search=Stopping%20resuscitation), [Dunn - Patient relatives and resuscitation](x-devonthink-item://BE17313F-56E2-4DAC-818C-031F61AD236E), [ANZCOR - prognostication in comatose pts after resus from cardiac arrest](x-devonthink-item://89EBD800-B1F9-4395-8FF7-26A8472BFD07?page=11), [CoSTR recommendations](https://costr.ilcor.org/document/?q=cardi&category=,advanced-life-support,pediatrics,neonatal-life-support&domain=,emergency-care,cpr,post-arrest&date_from=&date_to=&status=&reviewType=+OR+systematicReview+OR+scopingReview+OR+evidenceUpdate&order=date), [Pulm CCM - duration of CPR for non-shockable in-hospital arrest](https://www.pulmccm.org/p/how-long-should-cpr-be-performed-a7f), [Pulm CCM - duration of CPR shockable in-hospital arrest](https://www.pulmccm.org/p/how-long-should-cpr-be-performed-802) see also: [[FELS]], [[Cardiac arrest#post-arrest care|post-ROSC care]], [[ECMO#Patients who are not suitable for E-CPR|ECMO STOP criteria]] > [!key points] Please note > These time frames can be emotionally difficult. In some cases such as neoresus, there is variability in the appropriate duration. In others such as ongoing resuscitation post traumatic arrest, the decision to cease care may feel more straightforward. Regardless, please communicate these decisions clearly to your team, solicit feedback, and follow up care/ [[Debriefing]]. Care should be provided in a way that is focused on the the patients' best interests, comfort and dignity, and on support of the family. | situation | duration | explanation | | ----------------------------------------------------- | ------------------------------------------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | [[Neonatal life support\|neoresus]] | ~20 min[^1] | - [APGAR 0 at 10 minutes](https://www.neoresus.org.au/learning-resources/key-concepts/discontinuation/) has a combined rate of *death or severe disability* of 97-98%<br>- failure to achieve ROSC despite 10-20 min of intensive resus is a/w a ↑ risk of mortality and mod-to-severe neurodevelopmental impairment in survivors. <br>- "ANZCOR suggests that a reasonable time frame to consider this change in goals of care is around 20 minutes after birth. (CoSTR 2020, weak recommendation, very low-certainty evidence)" | | refractory VT / VF [[Cardiac arrest]] | 20-60 min | - consider [[ECMO#Patients who are not suitable for E-CPR\|ECMO STOP criteria]]<br>- intubated pts with ETCO2 during CPR <10 mmHg at 20 min very low survival<br>- *POCUS* - absence of cardiac kinetic activity has <5% probability of ROSC | | [[Pulmonary Embolism]] cardiac arrest | CPR 30 min up to 90 min | continue CPR up to 90 min post thrombolysis | | [[Traumatic arrest]] | 10 min | - ANZCOR recommends continuation of ALS for up to 10 minutes after potentially reversible causes have been addressed<br><br>- indications for [[Resuscitative Thoracotomy]] include:<br><br>- stab wound to heart with pericardial tamponade <br>- *penetrating* chest trauma with signs of life in previous 10 minutes -- 2/3 survive besides for gunshot wounds (which is much lower)<br>- clear evidence of pericardial tamponade causing haemodynamic instability from blunt trauma (*rare* indication from blunt trauma)<br>- no indication if no vital signs >10 min | | [[Drowning#drowning prognostic indicators\|Drowning]] | submersion > 10 min likely unsurvivable | - 5% recovery for submersion > 10 min<br>- efficacy of initial resus influences outcome<br>- non-reactive pupils and GCS 5 on arrival in ICU best independent predictors of poor neurological outcome<br><br><u>CPR likely futile if:</u><br>- water temp >6 deg C and immersion time > 30 min<br>- water temp <6 deg C and immersion time > 90 min<br>- submersion > 10 min without hypothermia (most cases in Austtralia)<br>- K > 11 mmol<br>- frozen blood | | [[Hypothermia]] | - generally will re-warm for a while<br>- may defer defibrillation and drugs until core temp > 30 deg C | - some advocate continue resus until rewarmed to normal core temp<br><br><u>factors which may identify unsurvivable patient:</u><br>- K > 10<br>- core temp <7 deg C<br>- core temp <15 deg C and no circulation for > 2 hours<br>- pH <6.5<br>- large intracardiac thrombus on ECHO<br>- severe coagulopathy<br>- blunt trauma + no vital signs + temp 32 deg likely lethal | | [[Cardiac arrest#OOHCA\|OOHCA]] | ~20 min if PEA, likely go longer if shockable | - 1-10% if first rhythm asystole<br>- 5-10% if PEA<br>- 10-35% VT/VF<br><br>15% for pts with VT/VF and witnessed arrest<br><br>*POCUS* absence of cardiac kinetic activity has <5% probability of ROSC | | PEA arrest | ~ 20 minutes | - if no ROSC, perfusing cardiac rhythm, or reversible causes identified that would change outcome. <br>- The 2015 AHA guidelines recommended using end-tidal CO2 measurements[^3] of <10 mm Hg after 20 minutes of CPR as part of a multimodal approach to support the cessation of resuscitation efforts[^2] | | other | - intubated pts with ETCO2 during CPR <10 mmHg at 20 min | | [^1]: see [neoResus - discontinuation of resuscitation](https://www.neoresus.org.au/learning-resources/key-concepts/discontinuation/) for more information about the ethical considerations and [ANZCOR guideline 13.10 - ethical issues in resuscitation of the newborn](https://www.anzcor.org/home/neonatal-resuscitation/guideline-13-10-ethical-issues-in-resuscitation-of-the-newborn/) for more information. [^2]: [Circulation 2015 - Duration of Cardiac Arrest Resuscitation: Deciding When to “Call the Code”](https://www.ahajournals.org/doi/10.1161/circulationaha.116.021798) [^3]: Doppler ultrasound is likely [far better](https://www.sciencedirect.com/science/article/abs/pii/S0300957223000084) than ETCO2 or manual pulse checks for predicting ROSC in cardiac arrest.