Knowing when to stop performing CPR is very important. If done right and in a timely manner, the CPR technique can significantly increase the chances of survival in out-of-hospital incidents, such as suffocation and cardiac arrest. These incidents happen more than 330,000 times within a single year solely in the United States.
Although most people are acquainted with the cases in which CRP is needed, it’s rarely addressed when you need to stop the technique. Even a CPR-certified person may need further assistance in determining when to stop performing CPR.
5 Situations When You Should Stop Performing CPR
As we mentioned, the main focus is usually on when to give CPR, so it’s rarely paid attention to when to stop it. Below are some cases when you know that CPR compressions or rescue breaths need to be terminated.
- The Person Dies
This reason can be a bit tricky since there have been a lot of cases where patients may recover from a short stage of clinical death, but their gasping has given out the wrong impression to stop performing CPR. Thus, it’s recommended to at least wait (if possible) for the emergency team to land on site before declaring a person dead.
However, there are some situations where you can assess for yourself. For example, excessive bleeding often results in a person’s death. In these cases, CPR is useless because the technique works best with those experiencing sudden cardiac arrest.
Below we give you the basic “death stages” so you can determine whether or not a person can be saved with CPR.
The Stages of Death
Scientifically speaking, death has three stages or three post-mortem intervals:
Immediate PMI
This is the earliest phase of death, where the body doesn’t necessarily become cold, but the signs of death and lack of circulation are visible as the eyes and skin turn pale. The eyes don’t just begin to lose their color but their puffiness as well.
The most recognizable sign of this stage is lividity. If the person’s eyes and skin have begun going slightly blue or purple, there’s no reason to apply CPR anymore.
Early PMI
The early stage of the post-mortem interval lasts from 3-72 hours, depending on the environment and the temperature. Within this phase, there are three different sub-stages:
- Algor Mortis
This is the first early stage of death when the body starts cooling off. According to scientific examination, the human body loses approximately 1.5 degrees celsius every other hour that passes by.
- Rigor Mortis
The second stage of death is the stiffening of the muscles, which usually starts in the facial area. This stage takes place merely 2 hours after the cause of death.
- Livor Mortis
The last phase of the classical trait of the stages of death is the phase after the 12th hour of dying. The body is blue, with a distinctive color totally different from the regular bruises. Also, in most cases, the mouth will be completely dry.
Late PMI
The absolutely obvious phase of death is the decomposition of the organic body tissue. It’s an unpleasant sight accompanied by an odor, which can’t pass unnoticed even by people that are not medically educated.
- You Feel Fatigue
Depending on your personal physical abilities and training, performing CPR can be rather exhausting. It’s very similar to a cardio exercise, considering you should push with both effort and speed to reach around 100-120 compressions within a single minute.
If you combine this with the traditional mouth-to-mouth method, you should ideally perform 30 compressions and then apply 2 open mouth-to-mouth breaths, holding the victim’s nose closed. If you’re feeling fatigued, you won’t be able to properly ventilate their airways, and all your previous efforts might be in vain.
In this case, keeping up with the tempo until someone more professional reaches out will rarely be possible. This is why CPR is usually done by a team. However, not all situations allow for such an act. In those cases, it’s advised to take a short break or ask someone else to replace you in the process.
Another thing you could try is to persist with the compressions in the center of the chest but with a decreased stimulation force. That will be a good rule to keep in mind to know when to stop performing CPR.
3. Normal Breathing
If you get some signs of life and a regulated breathing tempo in the unconscious victim, then you can stop giving CPR. After regular breathing is back, it should be a matter of minutes until the person is fully back to consciousness.
This means that the person has also experienced a return of spontaneous circulation (ROSC) due to the normalizing of the airways. It may come along with struggles to get as much air as possible or coughing, and even a panic attack.
However, if you stop performing CPR and the victim still doesn’t regain consciousness, consider repeating the procedure all over again in the same order until you reach signs of normal breathing.
4. You’ve Been Applying CPR for More Than an Hour
If, in some cases, the 911 or EMS hasn’t arrived within half an hour and your victim is still not regaining their cardiac rhythm, this is a sign to stop performing CPR. If you haven’t witnessed the cause of such a situation, it’s safe to assume that a heavy injury or some other serious medical condition (like a heart attack) may have occurred. In such cases, performing CPR longer than 40 minutes or an hour is not recommended.
However, in cases of toddlers and infants, this step should be overseen, and the baby should be taken to the hospital as soon as possible, without giving up at any instance. The main reason for this is that children have a better chance of survival than the average adult.
5. In Cases of a Do-Not-Resuscitate (DNR) Order
Despite the fact that CPR can significantly increase the chances of survival, the recovery rate of those who do survive a cardiac arrest is even lower in patients with a history of chronic diseases, surgeries or cancer.
Thus, back in the 1970s, hospitals developed some ethical considerations for these patients and have taken advanced directives into pursuing these DNR orders, which prevent a by passer or a medical person to start performing CPR or take other medical interventions to regain this person’s pulse. These orders are taken into legal consideration and can produce a legal trial if not implied.
Of course, a regulated procedure has to be applied before giving out someone such a right. People with cancer, elders in comfort care, or long-term hospital patients are those that usually acquire such an order. But, every adult who has the capacity to contract is free to acquire a DNR order from their doctor.
A DNR order can be canceled at any time, but only by the person that has signed the order, meaning that their family and relatives have no such rights.
A Full Understanding of When To Stop Performing CPR
Out-of-hospital cardiac arrests happen very often, mostly in homes and residences when people are alone and there’s no one to assist them. Each minute lost in assisting these persons with proper CPR increases the risk of death by 10%.
Assisting someone in this particular time of need is important, but on the other hand, you should also know when to stop performing CPR. Depending on the situation and external conditions, you should either transport the person to a safer location or immediately stop performing CPR.
At the same time, a more competent medical person should be the one to declare whether the person is dead. Note, however, that you shouldn’t stop the compressions and wait for the EMTs to arrive; instead, you need to keep the same pace until a professional comes on the site, which shouldn’t take more than 7-14 minutes.