We usually focus on when to give someone CPR and it’s performed. What many people don’t learn is when to stop CPR, or circumstances that may make CPR inappropriate. Obviously, the sooner CPR is started, the better. However, it is unrealistic to say CPR should be performed for 3 hours or more. Here are 4 general criteria for making the determination of when to stop CPR:
1. Obvious Death
When you witness cardiac arrest, starting CPR immediately gives the victim the highest chance of survival. However, sometimes cardiac arrest is not witnessed and the victim is found unresponsive after an unknown amount of hours. It’s also possible the deceased may have non-viable injuries, such as catastrophic brain trauma. When discovering an unresponsive victim one must assess the person to see if starting CPR is necessary. Here are the signs to look for:
Cold To the Touch
If you touch a person and they are very cold to the touch, this is usually an indication that they are beyond the point of being revived by CPR. However, surroundings should be taken into account. If a person is outside in cold weather or a drowning victim, they may be examples of where feeling the skin could give false indications.
In contrast, bodies are often found in bed with several layers of blankets over them. While they may have been dead for hours, their skin will generally feel very warm. These things should be taken into account when assessing when to start CPR.
Wikipedia’s definition of rigor mortis is “(Latin: rigor “stiffness”, mortis “of death”), the third stage of death, is one of the recognizable signs of death, caused by chemical changes in the muscles post mortem, which cause the limbs of the corpse to stiffen. In humans, rigor mortis can occur as soon as 4 hours post mortem.”
This is a very late sign of death. If you find a victim completely stiff with limbs that do not freely move, it is unfortunately too late to start CPR. A person will stiffen in whatever form they are in. Occasionally people are founded seated on the toilet after rigor mortis has set in. This means their body will be stiffened in the seated position.
Livor Mortis (Lividity)
“Livor” refers to the bluish color you’ll find on someone who has been deceased for several hours. It is caused by blood settling and eventually permeating the skin. It resembles bruising but will cover large portions of the body.
Lividity always occurs at a person’s center of gravity. For example, if someone is lying face down, they will generally have lividity on their face and front torso. This sign can commonly be hidden either by clothes or is only seen when the person is rolled over. Regardless, if lividity is recognized, it is a definitive sign of death.
Injuries Not Compatible With Life
These kind of injuries are significant and will overrule even the best attempts of CPR. Examples of this would be decapitation, amputations of the torso, etc. Some EMS services have protocols which discourage Paramedics from starting CPR on any major traumatic arrests.
A traumatic arrest is when someone has a trauma such as an amputation that causes them to bleed excessively and to the point that their heart goes into cardiac arrest. Performing CPR is counter-intuitive in this circumstance because there is no blood to circulate with compressions and no red blood cells to carry oxygen from rescue breaths.
2. Physical Fatigue
Unlike in the movies, CPR usually doesn’t bring someone back to life after just a few pumps on the chest. It’s not uncommon for CPR to take 30min to 1.5hr before a person responds. In fact, research has shown that longer resuscitation efforts improves brain function in survivors.
CPR is very tiring. A person burns 165 calories after 15min of CPR. The American Heart Association says, though, that CPR given for a full 38 minutes can produce major improvements. In fact, the younger a person is, the longer you should attempt to perform CPR because of the increased likelihood of resuscitation. In 2015, a toddler was revived after performing CPR for 1 hour and 41 minutes. However, if you’re doing CPR by yourself, you can can only go for so long before you may need to stop due to fatigue.
If you cannot physically continue to perform compression it’s appropriate to stop CPR. While people can sue for anything, there are no legal grounds to hold a person liable in this situation. Stopping CPR due to fatigue is protected under the Good Samaritan law in every US state.
3. Signs of Life
When CPR is performed outside of advanced medical care, guidelines do not recommend reassessment for a pulse every 2 minutes. If CPR is started, CPR is to be continued for as long as possible without interruption until obvious signs of life appear.
There are some key signs of life to look for as an indication of when to stop CPR. Here are the primary signs to look for in a victim:
- Purposeful movement. If a person moves their arm, lifts their head up, grimmaces etc.
- Making Sounds. There maybe involuntary sounds that occur during CPR, such as inconsistent ‘agonal breaths’. However, to stop CPR you are listening for more obvious sounds such as moaning or speaking.
- Eye movement. The opening of eyelids is not enough reason to stop CPR unless if there is eye movement. You’re looking for the victim to be blinking their eyes, looking around, and/or focusing on objects.
These signs of life are rare in an out-of-hospital setting but can happen. If you stop CPR after seeing these signs of life, and the person becomes unresponsive again, resume performing CPR.
4. Advanced Help Arrives
Lastly, if advanced help arrives and takes over CPR, one may stop CPR. Advanced help is generally considered a professional first responder such as a Paramedic or Firefighter. They may request that you continue doing compressions if you’re willing and able while they get their equipment in place. Other times, you may be asked to stop so they can take over immediately.
In urban areas advanced help generally arrives in 5-10 minutes. However, in rural areas, the response time may be 30 minutes or significantly longer.
Common CPR Mistakes
Many people have misconceptions about how to perform CPR. Watch this video to learn more:
There are many factors to take into account before making the determination when to stop CPR. In most instances, you will never be forced to make that decision. With very rare exceptions, you can usually count on EMS arriving and taking over before you would ever think about stopping.
If you have never taken a CPR class before, you should be considering it by now so you are prepared to act in an emergency. Learn more about our CPR classes. Leave us a comment or question below, we’d love to engage with you.
Prime Medical Training provides life-saving training taught by real emergency responders. You can view our current locations where we have regularly scheduled classes, or request for us to do on-site training at your location.
Can you elaborate?
You forgot when the scene becomes unsafe.
While that is true, the intent of the article was to define medical indications related to the patient to stop CPR. Thanks for your comment, though!
You forgot the age and condition of the patient. If a 95-year-old with end-stage heart, lung, and kidney disease goes into cardiac arrest and presents to the hospital in ASYSTOLE for 45 minutes, with no CPR for the first 10 minutes, it’s not the same as when a previously healthy child goes into cardiac arrest and receives immediately CPR and presents to the hospital 10 minutes later. In one instance CPR may represent an exercise in futility .
Michael, great point. This article is geared towards lay responders and people in the healthcare industry do have different considerations to take into account.