OK, so i agree in theory with field termination of effort. However, please remember that we all are in very different places with very different rules and resources. In MD, without rigor AND lividity, and in absence of "Injuries Incompatible with Life", it can be difficult at best to terminate efforts. It requires the MD agreeing, and even with the best advocate clearly painting the picture of futility, many if not most of our ED MD's want to make the call after THEY look at the patient. And I do say look because I have seen them hop in the back of unit outside ED after an hour or more of CPR and call it there.
As for ped's (and others in special circumstances), I have a somewhat unique outlook on them. Having worked as a member of a dedicated Pediatric Critical Care Team, that transports only ped's, I have worked at least a few dozen ped arrests in a few years, and have seen extended CPR times that resulted in positive outcomes. Yes it is rare. But even after EMS transport to local ED, ED time, our response time of 25 minutes to that facility, load time, and return time, the patient's recovered after the heart rested on ECMO for some time. Again, rare, but we are in an area where any of our hospitals are within a 15 minute flight of two of the nations top pediatric center's.
That said, that was a pediatric patient with a undiagnosed heart defect that went into arrest because of the stress on the heart. Good cpr was performed from time of arrest.
My point is that consideration needs to be given to the circumstances, distances to specialty centers, resources, etc. However, with signs of death, why start CPR? In that case, remember that the parents are also patients, victims of stress. Empathy can go a long way. On all my pediatric transports, wether 911, or critical care team, I make sure somebody is acting as a liason to the family.
