Cardiopulmonary resuscitation (CPR) is an emergency procedure designed to temporarily maintain blood circulation and oxygenation until advanced medical assistance can take over. When a person’s heart or breathing stops, CPR delivers artificial circulation and ventilation, keeping oxygen flowing to the brain and other organs. The decision to stop CPR is complex and depends heavily on whether the rescuer is a layperson or a trained medical professional. Understanding the distinct circumstances that justify ceasing resuscitation efforts is important for anyone who might find themselves in this role.
Criteria for Lay Rescuers to Cease CPR
A bystander without professional medical training is justified in stopping CPR under specific, practical circumstances. The most common reason is the arrival of trained medical personnel, such as Emergency Medical Services (EMS) or a firefighter trained in advanced life support. Once these professionals are on the scene and ready to assume care, the lay rescuer should step back and allow them to take over the resuscitation effort.
Rescuer exhaustion is another recognized reason for a layperson to stop performing CPR. Delivering effective chest compressions requires significant physical exertion, and the quality of compressions rapidly diminishes when the rescuer becomes severely fatigued. High-quality compressions (at least two inches deep at a rate of 100 to 120 per minute) are fundamental to patient survival, making ineffective efforts counterproductive. A rescuer should stop when they are physically unable to maintain the required compression depth and rate.
The environment itself can necessitate the cessation of CPR if the scene becomes unsafe for the rescuer. If a new hazard emerges, such as a fire, structural collapse, or uncontrolled traffic, the rescuer must prioritize their own safety. Additionally, a lay rescuer should not initiate or continue CPR if the person shows definitive signs of irreversible death. These signs include dependent lividity (pooling of blood) or rigor mortis (stiffening of the body).
Medical Termination of Resuscitation Protocols
Trained medical personnel, like paramedics and emergency medical technicians, follow established protocols for the termination of resuscitation (TOR). These protocols are structured, physician-approved guidelines that determine when continued efforts are medically futile in the out-of-hospital setting. A common rule for nontraumatic cardiac arrest is the absence of a return of spontaneous circulation (ROSC) after a defined period of advanced life support, often 20 minutes.
Specific criteria within TOR protocols often include factors such as the arrest not being witnessed by EMS and the initial heart rhythm being non-shockable (e.g., asystole or pulseless electrical activity, PEA). In many systems, EMS providers must consult with a medical control physician before formally terminating resuscitation efforts in the field. This physician oversight ensures that all appropriate interventions have been attempted according to established medical guidelines.
Medical professionals may also decline to initiate or terminate resuscitation immediately if the patient has injuries incompatible with life, such as massive trauma, or clear signs of prolonged death, like decomposition. These protocol-driven decisions balance the goal of saving a life with the appropriate use of medical resources and the recognition of medical futility.
Legal Protections and Patient Wishes
The fear of legal liability often causes bystanders to hesitate before initiating CPR, but Good Samaritan laws are in place to address this concern. These laws provide legal protection to lay rescuers who voluntarily offer reasonable assistance to an injured or ill person in good faith. This protection shields the rescuer from civil liability, even if the person is unintentionally harmed while attempting to save their life.
The presence of a Do Not Resuscitate (DNR) order is another factor that influences the decision to perform or stop CPR. A DNR is a legal medical order, signed by a physician, instructing that CPR should not be performed if the patient’s heart or breathing stops. For a lay rescuer, the general guidance is to begin CPR immediately unless clear, official documentation (such as a specialized bracelet or form) is immediately presented.
Lay rescuers are not expected to stop and search for legal documents, as precious seconds are lost during cardiac arrest. Good Samaritan laws support the action of a lay rescuer providing aid, even if a DNR order exists, because the rescuer is acting in good faith without knowledge of the order. Only trained medical personnel, who are required to honor valid DNR orders, should cease efforts based on this legal documentation.