Cardiopulmonary Resuscitation, or CPR, is a time-sensitive, lifesaving procedure performed when a person’s heart has stopped beating. It involves manual chest compressions, often combined with rescue breaths, to artificially circulate oxygenated blood to the brain and other organs. CPR is a temporary measure designed to delay tissue damage and maintain minimal blood flow until professional medical care can take over. Knowing when to stop efforts is a critical consideration that depends entirely on the circumstances and the training of the rescuer.
Termination Rules for the Lay Rescuer
A bystander or lay rescuer, often a person with basic CPR training, should continue performing compressions without interruption until one of three distinct scenarios occurs.
Rescuer Exhaustion
The first reason for stopping is complete rescuer exhaustion. High-quality chest compressions require considerable physical effort, and ineffective compressions serve no purpose. A layperson should cease efforts only when they are physically unable to continue effective compressions.
Unsafe Scene
Another reason to stop is if the scene becomes unsafe for the rescuer. If a new hazard arises, such as traffic, fire, or a collapsing structure, the rescuer must prioritize their own safety immediately and move away from the danger.
Arrival of Higher-Level Care
The third practical reason for a lay rescuer to stop is the arrival of higher-level care, such as Emergency Medical Services (EMS), fire personnel, or another trained responder. When trained professionals arrive on the scene, the lay rescuer should step aside and allow them to take over the patient’s care. Lay rescuers should not stop simply because they believe the patient has died, but should continue until one of the three clear termination points is reached.
Medical Direction and Professional Termination
Trained medical professionals, such as paramedics and hospital staff, stop resuscitation efforts based on structured clinical assessment and established protocols, which differ significantly from the lay rescuer’s practical limitations. These professionals follow Termination of Resuscitation (TOR) guidelines established by medical directors to determine when efforts are medically futile. Protocols often dictate that resuscitation may be terminated after a defined period of advanced life support, typically 20 to 30 minutes, without the return of a spontaneous heart rhythm.
Clinical Futility
The patient’s initial heart rhythm is a significant factor in this decision. For example, a rhythm like asystole (a flat line) or pulseless electrical activity that does not respond to treatment may meet the criteria for termination. Professional teams also use advanced monitoring tools, such as measuring the carbon dioxide in the patient’s exhaled breath. If this measure is persistently low despite treatment, it can indicate a poor prognosis and support the decision to stop.
Legal Directives
Another major factor is the presence of legal documents, such as a Do Not Resuscitate (DNR) order or an advanced directive, which explicitly state the patient’s wish to forgo resuscitation attempts. In these cases, efforts should not be initiated or must be stopped immediately upon confirmation of the order. Once the decision to terminate is made, a qualified medical professional, such as a physician, formally pronounces death.
Stopping When the Patient Recovers
The most positive reason to stop CPR is when the patient shows signs of life, indicating a successful resuscitation. This event is medically termed the Return of Spontaneous Circulation (ROSC). ROSC means the patient’s own heart has started beating effectively enough to restore blood flow.
A lay rescuer should look for clear signs of ROSC. These signs include the patient beginning to breathe normally, moving purposefully, or coughing. The rescuer may also be able to detect a pulse, indicating the heart is pumping blood again.
Once these signs of life are observed, the rescuer should immediately stop compressions. The focus then shifts to monitoring the patient’s airway and breathing until Emergency Medical Services arrive. The patient should be placed in a recovery position if they are breathing on their own, and the rescuer must continue to monitor for any loss of circulation.