As a trained first aider or first responder, you are expected to start CPR immediately after you determined absence of pulse and breathing during an emergency situation. Even if the patient is very old or is terminally ill, providing basic life support should not be withheld, as if CPR is an instinct. However, there are some situations wherein withholding CPR is both logical and legal.
Important disclaimer: the material posted on this blog on when not to start and when to stop CPR is for information purposes. To learn more about legal issues behind providing CPR and when to stop CPR enrol in workplace approved first aid training (sign up here).
The American Heart Association lists the following circumstances when not to start CPR:
- if performing CPR would put the rescuer at risk of serious injury or danger;
- if there are obvious signs of irreversible death, such as:
- a line of lividity – the victim has been dead for more than 15 minutes and blood has already pooled in dependent body parts
- rigor mortis – the body has stiffened, occurs within 4 to 10 hours after the heart has stopped beating
- obvious mortal wounds – extensive injuries that would render CPR useless (decapitation, severed body, incineration, and transection)
- decomposition; and
- if there is a valid, dated, and signed advanced directive that specifically indicate withholding resuscitation, OR, in case of hospitalized patient, a valid, dated and signed DNAR order.
DO NOT REFUSE starting CPR even if bystanders or families ask you not to provide CPR or tells you that the patient has been on cardiac arrest for more than 10 minutes. Usually, the moment the victim has passed out and the moment the victim’s heart has stopped are not always the same. The victim may only be unconscious but actually have effective blood circulation. Aside from AHA’s recommendations, you should also consider local protocols and regulations in your area.
Trained first aiders are taught that once CPR has been started it should be continued until any of the following circumstances occur:
- if there is spontaneous circulation but artificial respiration is still given;
- if there is spontaneous circulation and breathing;
- if another trained rescuer or rescue team has taken over the life support;
- if the rescuer is too exhausted and unable to continue;
- if there is an immediate danger or continuation of CPR places others in mortal peril; and
- if reliable and valid signs of irreversible death are identified.
Termination of resuscitation is often disheartening for the families, as well as for the first aiders. However, the situation should be tactfully explained to the victim’s loved one. Studies show that if heart beat and breathing is not restored after 30 minutes of providing resuscitative measures, the chance of survival is very slim, even nil. The outcome becomes even grimmer in the absence of an AED or if a good quality CPR is not initiated immediately and sustained continuously.
First aid training programs equip first aiders not just with basic life support skills but also proper judgment as to when to initiate, when not to initiate, and when to stop CPR. Contact your local workplace approved Chapter for training schedule.