Termination of cardiopulmonary resuscitation in mountain rescue

The aim was to establish scientifically supported recommendations for termination of cardiopulmonary resuscitation (CPR) in mountain rescue, which can be applied by physicians and nonphysicians. A literature search was performed; the results and recommendations were discussed among the authors, and finally approved by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) in October 2011. 4166 abstracts were reviewed; of these, 96 were relevant for this article and are included in this literature review. In mountain rescue, CPR may be withheld or terminated in a patient with absent vital signs when the risk is unacceptable to the rescuer, the rescuer is exhausted or in extreme environments where CPR is not possible or any of the following apply: decapitation; truncal transection; whole body incinerated, decomposed, or frozen solid; avalanche victim in asystole with obstructed airway and burial time >35 min. Also, CPR may be terminated when all of the following criteria apply: unwitnessed loss of vital signs, no return of spontaneous circulation during 20 min of CPR, no shock advised at any time by AED or only asystole on ECG, and no hypothermia or other special circumstances warranting extended CPR. In situations where transport is not possible, mitigation of special circumstances is not possible, and further resuscitation is futile, CPR should be terminated. Medical directors of rescue teams should interpret these recommendations in the context of local conditions and laws, and create team-specific training and protocols for determining when to withhold and terminate CPR in a patient with absent vital signs.