Verbeek et al developed a guideline for emergency medical technicians (EMTs) to discontinue resuscitation of a patient after a cardiac arrest. A key component is the availability of an automated external defibrillator (AED). The authors are from Sunnybrook & Women's College Health Sciences Centre, University of Toronto, and Queen's University in Canada.


Patient selection: Prehospital cardiac arrest


The automated external defibrillator (AED) monitors cardiac rhythm and delivers a shock if appropriate. Failure to discharge indicates a non-shockable cardiac rhythm.


Criteria for termination of resuscitation - all of the following:

(1) There is an absence of spontaneous circulation.

(2) No shock has been delivered by the automated external defibrillator at the scene.

(3) The arrest was not witnessed by an EMT.


In all other situations resuscitation is continued and the patient is transported immediately to the nearest Emergency Department.


Return of spontaneous circulation, shock prior to transport and a witness cardiac arrest were found on multivariate analysis to be associated with survival. The absence of all 3 indicates an extremely low probability of survival.


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