Q: Is it standard to stop CPR after 30 minutes of cardiac arrest in the wilderness setting?

Q: During my WAFA training, we were told to stop CPR after 30 minutes of cardiac arrest. Are there other agencies/organizations that use this standard of care/treatment? Have there been any conflicts?

If you are in a wilderness or remote setting, the simple answer is yes.

In this setting, we believe that if normothermic (normal body temperature) people in full cardiac arrest do not recover within 30 minutes of continuous CPR, they will not survive.  This, even in the unlikely event of the arrival of advanced life support (ALS)/Emergency Medical Services (EMS) at or near that 30 minute mark.  This number is a conservative estimate derived from the medical literature.  The magic number is probably closer to 20 minutes or less.

Large organizations like the American Heart Association (AHA) and the American Red Cross have focused their attention on settings where automatic external defibrillators and ALS are readily available.  As a result they have not addressed this question of futility, leaving it to medical control.  Some EMS regions have, adopting guidelines similar to ours for use in the urban settings.

The AHA continues to downplay the role of pulse checks for lay providers (which would include WAFA-level training) during assessments of unresponsive people.  While it may make sense to start CPR without assessing pulses in unresponsive, non-breathing patients, we will still use no pulse as one of the criteria for stopping.

Although I am not aware of any problems applying this guideline in the field, I am aware of cases where rescues have continued for 2 hours or more, putting themselves and others at risk.  The outcome have been the same.

Bottom line: In the wilderness or remote setting, stop resuscitation if there is no pulse after performing 30 minutes of continuous CPR.

3 comments on “Q: Is it standard to stop CPR after 30 minutes of cardiac arrest in the wilderness setting?

  1. Primi Ranola Primi Ranola

    Hi, what is this “medical literature” you speak of deriving this 20-30 minute time constraint. Can you provide the name of any published authors or sources? Thanks!

  2. Mark Brauner Mark Brauner

    I would like to see these references as well…

  3. MaryLou Lewis, MD MaryLou Lewis, MD

    Please include the references. there seems to be no standards to guide the clinicians.

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