How long must cardiac arrest be refractory to be considered for termination?

• A. At least 20 minutes
• B. At least 5 minutes
• C. No minimum time
• D. At least 1 hour

Answer: (A)

When deciding to stop CPR in a refractory cardiac arrest, a duration threshold helps determine futility. In many termination-of-resuscitation rules, if there is no return of spontaneous circulation after a minimum period of ongoing, high-quality CPR, the chance of meaningful survival is extremely low, so termination can be considered. That minimum period is twenty minutes, which is why the correct choice is the one stating twenty minutes. Shorter times could end too early and miss late ROSC, while longer times (like an hour) aren’t the standard threshold in these guidelines. Remaining factors, such as whether ROSC occurs, presence of reversible causes, or specific clinical signs, can influence the decision, but the twenty-minute mark is the commonly used benchmark to consider termination in the field.