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What we are going to do now is have a look at the decision-making process when it comes to terminating resuscitation. This is possible and advisable when a patient is being asystolic, or is in a broad-complex PEA of less than 60 beats a minute for 20 minutes or more, despite resuscitation attempts. Continuing resuscitation in a patient beyond 20 minutes, in these circumstances, would be futile. So we join the scenario now, the patient is in asystole. My colleague's been doing CPR, with advanced life support measures, including advanced airway management and the use of adrenaline, for 20 minutes. Right, Duncan, can you just stop so we can assess the rhythm? Okay, we can confirm that the patient's still in asystole?

Yeah, asystole.

Yeah. Okay. Leads are on correctly?


And we also need to confirm that the patient is not less than 18 years old.

Yeah, confirmed.

The patient's not hypothermic or drowned?


And there's no traumatic cardiac arrest with penetrating injury?

No. Not at all.

And the patient's male, so therefore not pregnant. So, would you agree to stop resuscitation on this patient now?

Yeah. Leads are all in place, asystole. Yeah, I'd agree.

Okay, let's stop then. And that's a difficult decision to make sometimes, on a younger patient in particularly, but continuing CPR beyond 20 minutes when a patient's been in asystole, and they don't fit any of the criteria, I.e., all children under the age of 18 must be transported to a Resus department; patients who have drowned or who are hypothermic, CPR must continue until they are normothermic at least; a patient with penetrating trauma, I.e., a stabbing or a gunshot wound, must be transported to hospital, where they can be administered blood products. And patients who are pregnant, of course with resuscitating them, the mother is a priority, with an aim to save the baby as well.