Discontinuing Resuscitation in the Out-of-Hospital Setting

Revised and approved by the ACEP Board of Directors June 2008
Reaffirmed by the ACEP Board of Directors October 2002
Originally approved by the ACEP Board of Directors September 1997 

The American College of Emergency Physicians believes that under certain well-defined circumstances, resuscitative efforts may be discontinued in the out-of-hospital setting for pulseless patients who do not respond to an adequate trial of resuscitation therapy. The literature demonstrates that these are situations in which resuscitative efforts would be unlikely to provide medical benefit to the patient.

Patients for whom resuscitative efforts may be discontinued in the out-of-hospital setting include patients who are asystolic or are in a wide-complex pulseless bradycardic rhythm with a rate less than 60, are normothermic, and fail an adequate trial of resuscitation therapy. Adequate resuscitation therapy may include airway management, CPR, medications, defibrillation, and pacing.

When a process for field termination is established, a psychosocial support system should be available to help family members and friends. Local EMS systems must work together with appropriate local agencies to develop effective policies for field termination of resuscitation, to include appropriate involvement of medical control.