Comilla Sasson and colleagues have an article in the current issue of JAMA titled Prehospital Termination of Resuscitation in Cases of Refractory Out-of-Hospital Cardiac Arrest.
They identify criteria for stopping resusciation efforts by EMS personnel:
Cardiac arrest not witnessed
No external defribilator applied out of hospital
No spontaneous circulation out of hospital
CPR not administered by bystander
Few patients (0.1% of 5500 studied) who are resuscitated and brought to the hospital by EMS survive to hospital discharge. Zero who met the criteria for stopping survived. Assuming this is an appropriate measure of inappropriate treatment, the stopping rules have a high validity.
The authors offer some benefits for following the stopping rules:
Reduce risk EMS during transport
Decrease pressure on EMS systems
Allow EMS to focus on patients with greater survival odds
Decrease admissions to ICUs of patients with no chance of survivial
Arthur Sanders has an editorial on the study suggesting that stopping rules may be unnecessary and may thwart developments in emergency treatment.