What are the AHA guidelines for withholding or discontinuance of cardiopulmonary resuscitation (CPR) in neonates?

Updated: Sep 15, 2020
  • Author: Catharine A Bon, MD; Chief Editor: Kirsten A Bechtel, MD  more...
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Answer

Answer

The guidelines offer the following recommendations for withholding or discontinuance of resuscitation [43] :

  • It is possible to identify conditions associated with high mortality and poor outcome in which withholding resuscitative efforts may be considered reasonable, particularly when there has been the opportunity for parental agreement (class IIb)

  • In infants with an Apgar score of 0 after 10 minutes of resuscitation, if the heart rate remains undetectable, it may be reasonable to stop assisted ventilations; however, the decision to continue or discontinue resuscitative efforts must be individualized (class IIb)

  • Variables to be considered may include whether the resuscitation was considered optimal; availability of advanced neonatal care, such as therapeutic hypothermia; specific circumstances before delivery (eg, known timing of the insult); and wishes expressed by the family (class IIb)

  • When gestation, birth weight, or congenital anomalies are associated with almost certain early death and when unacceptably high morbidity is likely among the rare survivors, resuscitation is not indicated (class IIb)

  • Under circumstances when an outcome remains unclear, the desires of the parents should be supported (class IIb)


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