General Resuscitation Guidelines

Question 1

In what cases must the QAS clinical consult line be contacted within 15 min of CPR commencement?

Answer 1

1. Patients under 18 years
2. Hypothermia
3. Suspected toxicology/toxinology cause
4. Post QAS fibrinolysis administration
5. Pregnancy
6. STEMI diagnosed prior to arrest
7. Suspected PE
8. Evidence of CPR induced consciousness

Question 2

When is it appropriate for CPR to be withheld?

Answer 2

1. Where the patient is exhibiting obvious signs of death including:
   - Decomposition
   - Putrefaction
   - Hypostasis
   - Rigor mortis
2. Where the patient has sustained injuries that are totally incompatible with life such as:
   - Decapitation
   - Hemicorporectomy (or similar massive injury)
   - Incineration
   - Foetal maceration
3. Where performing CPR may endanger the life, health or safety of the ambulance clinician.
4. Where a lawful direction to withhold CPR has been provided to the ambulance clinician.

Question 3

What are the 3 possible legal pathways for withholding or withdrawing CPR?

Answer 3

1. A decision made by the patient in an Advance Health Directive (AHD)
   - The original or certified copy must be sited
   - Should be reviewed every 2 years
2. A decision made by the patient’s legal guardian or attorney
   - The ambulance clinician must reasonably consider that the commencement or continuation of the life-sustaining measure for the patient would, having regard for all circumstances, be inconsistent with good medical practice.
3. A decision made by the patient’s health provider in an acute emergency
   - Can include the patient’s treating medical practitioner, a QAS medical practitioner (QAS medical director or ambulance medical officer), a QAS CCP or the attending clinician (but only when making decisions in accordance with the QAS rapid or general discontinuation criteria)

Question 4

What is the General Discontinuation Criteria?

Answer 4

CPR must be administered for a period of no less than 20 continuous minutes, after which resuscitation may be discontinued independently (without QAS clinical consult) if the following criteria are met:

1. No ROSC at any stage during resus
2. Cardiac arrest was not witnessed by QAS personnel
3. No shockable rhythm at any stage during resus

Question 5

What is the Rapid Discontinuation Criteria?

Answer 5

CPR may be discontinued after 20 continuous minutes if all of the following criteria are met:

1. The patient was observed to be unconscious, unresponsive to stimuli, not breathing and pulseless for at least 10 minutes prior to the arrival of the ambulance clinician
2. No CPR was provided during this period
3. The patient is exhibiting signs of life extinct
4. The patient’s cardiac rhythm is asystole or a broad PEA <40

Question 6

What is the Recognition of Life Extinct (ROLE) criteria?

Answer 6

The following criteria must be present before a determination can be made that life is extinct:

1. No palpable carotid pulse
2. No heart sounds heard for 30 sec
3. No breath sounds heard for 30 sec
4. Fixed & dilated pupils
5. No response to centralised stimuli

Question 7

What are the reversible causes of cardiac arrest?

Answer 7

1. Hypoxia
2. Hypo/hyperthermia
3. Hypovolemia
4. Hypo/hyperkalemia
5. Hydrogen ion (acidosis)
6. Tension pneumothorax
7. Tamponade
8. Toxins
9. Thrombosis