In Call of Duty 4, it gives a player the ability to survive a normally instant death by disabling the player to the ground in a supine position. Last Stand will not come into effect if a player is killed by a headshot,knife, (melee), impact (an unarmed Grenade Launcher grenade), or an explosive weapon (grenades, C4,RPG rockets or Claymore ). This perk is unlocked at level 8.

A player in Last Stand can only fire a pistol and use the knife melee. The pistol a player uses in Last Stand is the pistol that was selected as the sidearm; players with the Overkill perk or who have switched their pistols in game for a second primary weapon will use the standard M9 pistol when put into Last Stand. The player will also have maximum ammunition and a full magazine in the pistol, regardless of whether the pistol's magazine was empty or not prior to going into Last Stand. In addition, if a player is put into Last Stand while cooking a grenade, the player will still be able to throw it. Players can also detonate any deployed C4 by tapping the use key twice.

Last Stand will end if the player takes a single hit from an opposing player (or any player if in Hardcore mode), after 10 seconds has elapsed since the player was put in Last Stand, or if the player ends it his/herself by holding the use key (called the "Coward's Way Out"); this does not result in a suicide. Players holding a grenade when put into Last Stand mode can commit suicide by holding on to it, preventing the enemy who shot them from getting a kill without the death counting as a suicide. Also, players that were holding on to flash or stun grenades at the time they were put into Last Stand will automatically throw the grenade.

Any kills a player achieves while in Last Stand will count double towards their earned XP, though the extra points only count towards match bonus and are not factored into the displayed individual score or the team's score. For instance, in normal Team Deathmatch, a player getting a last stand kill will receive 10 points as match bonus in addition to 10 points for the kill that's counted on his and the team's score. This applies for any kill the player makes while they are in Last Stand; for instance if the player throws a grenade, gets put in Last Stand before the grenade explodes, and then that grenade kills an enemy player, the last stand player will receive the bonus points.

A player put into Last Stand mode becomes temporarily invincible during the transition into Last Stand. This accounts for players who survive nearby grenades and bullet shots when put into Last Stand. Hits against a player in invulnerability mode register as normal shots on the firing player's screen. Last Stand is also one of the most irritating perks for enemy players because of the vulnerability of the person in Last Stand. It is quite common for a friendly player to "kill steal", to shoot the person in Last Stand, therefore taking the kill for themselves. Some players use Last Stand in conjunction with a modded controller and a Desert Eagle to get multiple kills while in Last Stand, though it is rare.

Last Stand is mostly the same as in the Call of Duty 4, but you can crawl slowly now. 20 kills in Last Stand are required to upgrade to the pro version of the perk which allows you to use equipment while in Last Stand, such as a primary grenade, this allows the player to essentially commit suicide by cooking a frag/C4 or even throwing a stun grenade, flashbang in front of them, or planting a claymore which would deny the opposing team of points . There is also a deathstreak named Final Stand, which is activated after the player dies four times in a row (3 times with Hardline Pro) which is virtually the same as Last Stand Pro except the player can stand back up after a period of time, has a slightly higher amount of health and that the player can use all his weapons. Similar to the Call of Duty 4 version, the player has any Handgun or the M93 Raffica machine pistol complete with attachments. This means Akimbo may be suited for those using this perk for quick kills at close range, however this becomes less than useless at longer ranges. Also similar to CoD4, the player will pull out an M9 with no attachments if the player's secondary weapon is any other than a handgun or M93. Last Stand is unlocked at level 41.