In this patient in refractory cardiac arrest should I continue CPR for longer than 30Â min and, if so, how?

Cardiopulmonary resuscitation (CPR) is the only effective treatment for cardiac arrest (CA). However, when initial resuscitation efforts are unsuccessful, the resuscitation team should decide if and how CPR should be continued. Although the European Resuscitation Council 2015 guidelines indicate that stopping CPR should be considered if, in the absence of reversible causes, asystole has persisted for more 20 min despite ongoing advanced life support , how long CPR should be attempted in other circumstances is less clear. Extracorporeal CPR in the form of emergency veno-arterial cardiopulmonary bypass, can restore circulation in patients with prolonged CA in whom conventional CPR is unsuccessful. Regardless of the resuscitation technique used, prolonged resuscitation efforts are justified only in patients for whom a chance of a neurologically meaningful survival exists; therefore, patient selection is important.