1 Arrest is not witnessed - If the cardiac arrest is not witnessed or detected by telemetry such that the time between arrest and the when ACLS is initiated is unknown then resuscitation will not be provided, and if started, then will be discontinued.
2. Asytole- Patients who have asytole at the time of arrest or develop asytole during resuscitation will not receive ACLS or have ACLS protocol discontinued
Murphy et al: Annals of Internal Medicine 1989; 111 (3): 199-205
van Walraven et al: Journal of American Medical Association 2001;285: 1602-06
3. DNI Order- Patients who have a Do Not Intubate order will not receive ACLS protocol since the initial step in ACLS is to secure airway and provide respiratory support. Since this cannot be reasonably done and honor the DNI order, ACLS will not be initiated and if it has been will be promptly discontinued.
4. Return of spontaneous circulation - If spontaneous circulation is not restored within 10 minutes of initiation of ACLS protocol then resuscitation efforts will be discontinued.
5. Defibrillation - Electrical defibrillation is an effective treatment for ventricular dysrhythmia. However, if defibrillation is not effective in restoring spontaneous circulation within 10 minutes then the ACLS will discontinued
In-hospital versus out-of-hospital presentation of life-threatening ventricular arrhythmias predicts survival Epstein, A. et al. J Am Coll Cardiol, 1999; 34:1111-1116 .
Bourke Arch Intern Med 2001;161:1751-1758.
Temporal trends in sudden cardiac arrest: a 25-year emergency medical services perspective. Rea TD; Circulation 2003 Jun 10;107(22):2780-5.
Advanced cardiac life support in out-of-hospital cardiac arrest.
Survival is clearly more likely for …CPR durations of 15 minutes or less. Mortality increases from 44% for resuscitations less than 15 minutes in duration versus 95% for those that are longer. Survival is rare after 30 minutes of CPR.
Ch 16 Cardiopulmonary Resuscitation; Cohn et al., Cardiac Surgery in the Adult (NY: McGraw Hill, 2003)
age sometimes an independent predictor of survival…
and sometimes not….
Cooper et al., A decade of in-hospital resuscitation: outcomes and prediction of survival? Resuscitation 68(2006): 231-37. Danciu et al., A predictive model for survival after in-hospital cardiopulmonary arrest Resuscitation 62(2004):
Conclusions: Overall survival of CPR to hospital discharge in cancer patients compares favorably to survival rates in unselected inpatients. Improved outcomes in recent years in patients with metastatic disease are likely to reflect more selective use of CPR in cancer patients, with the sickest patients deselected.
Reisfeld et al., Survival in cancer patients undergoing in-hospital resuscitation: a metaanalysis. Resuscitation 71(2006): 152-60.