When to Stop CPR for Out-of-Hospital Cardiac Arrest?

The Universal Termination of Resuscitation Guidelines suggest that resuscitation should be terminated if at least four rounds of CPR have occurred and the following three criteria are met:

  • The arrest was NOT witnessed by emergency medical services (EMS)
  • There has been NO return of spontaneous circulation (ROSC)
  • No shocks were delivered.

This study used data from a large prospective database of adult patients with OHCA of presumed cardiac origin to test the performance of these Universal Termination criteria. In the study, 9467 patients did not achieve pre-hospital ROSC and were transported.  The following are results of the study:

  • 1.1% of these patients had survival with a good neurological outcome.
  • Patients who had a shock delivered or arrest witnessed by EMS had significantly higher survival (3.0% vs. 0.7%) and higher survival with good neurological function (1.7% vs. 0.3%) than those who met all three criteria for termination.
  • Among survivors with good neurological outcome, 90% had ROSC by 20 minutes and 99% by 37 minutes.

Based on this study, patients with OHCA should be transported to the hospital if they have ROSC, if they receive any shocks, or if the arrest is witnessed by EMS. Resuscitation should be terminated in OHCA in all other patients, especially if there is no ROSC within 30-35 minutes.


  1. Drennan IR et al. A comparison of the universal TOR Guideline to the absence of prehospital ROSC and duration of resuscitation in predicting futility from out-of-hospital cardiac arrest. Resuscitation 2017 Feb; 111:96.
Read all articles in Cardiovascular diseases, Emergency Procedures, Hematology, Medical General, medical procedures
Tags: cardiac arrest, CPR, HPC updates, out of hospital cardiac arrest, return of spontaneous circulation, ROSC

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