How long should CPR be continued in hypothermic patients before considering termination?

In cases of hypothermia, the guidelines indicate that CPR must be continued for an extended period due to the unique physiological response of the body to cold environments. Hypothermic patients can have a significantly delayed cardiac response and might appear to be in cardiac arrest even when they are potentially still salvageable. Therefore, it is advised that CPR should be continued for more than two hours before considering termination.

This allows adequate time for a possible spontaneous return of circulation, especially since some hypothermic patients may still have a viable heart that can be restarted once they are warmed up. The prolonged effort acknowledges the body's altered state and recognizes that hypothermia can fundamentally change the expected response to cardiac arrest. Hence, more than two hours of CPR is appropriate to ensure that all possible life-saving measures have been fully utilized before making the determination to stop resuscitative efforts.