When Should Pre-Hospital ACLS be Stopped? By Dr. George Anthony Fidacaro

Pre-hospital Termination of Resuscitation for Non-traumatic Cardiopulmonary Arrest


  • Over 300,000 people in the U.S. suffer an out-of-hospital cardiac arrest (OHCA); although survival from a cardiac etiology is improving, overall survival from OHCA has remained approximately 10%.
  • Despite their best efforts, pre-hospital providers will often transport patients to the hospital despite a failure to achieving ROSC. This practice results in unnecessary use of valuable resources and places the community and EMS providers at risk due to high-speed transportation.
  • The National Association of EMS Physicians published a position paper in 2011 supporting termination of resuscitation by EMS providers if the:
  1. arrest was not witnessed by an EMS provider
  2. patient has no shockable rhythm identified by an AED or other electronic monitor
  3. patient has no ROSC prior to EMS transport
  • In addition to above criteria, studies have also demonstrated poor survival if an ETC02 < 10 at 20 minutes of resuscitation.



  1. Levine RL, Wayne MA, Miller CC. End-tidal carbon dioxide and outcome of out-of-hospital cardiac arrest. N Engl J Med. 1997 Jul 31;337(5):301-6
  2. Millin MG, Khandker SR, Malki A. Termination of resuscitation of nontraumatic cardiopulmonary arrest: resource document for the National Association of EMS Physicians position statement. Prehosp Emerg Care. 2011 Oct-Dec; 15(4):547-54.
  3. Morrison LJ, Visentin LM, Kiss A, et al. Validation of a rule for termination of resuscitation in out-of-hospital cardiac arrest. N Engl J Med. 2006; 355:478–87