Patient Conscious During CPR

[Emergent, RN]

Amazing story told to me by an ER doc I work with. A patient he had, a fellow in his 30s, went into V-fib. Due to excellent CPR the patient was conscious throughout the code, which lasted almost 2 hours. They tried everything but could not bring back a rhythm.

He finally had to tell the man there was nothing else he could do, the guy gave a little nod and they let him go. He said it was the hardest thing he's had to do.

[klone, MSN, RN]

Huh. Not sure what to make of that.

[xoemmylouox, ASN, RN]

Huh. Not sure what to make of that.

Me either.

[Jensmom7, BSN, RN]

That's a very nice medical urban legend.

[klone, MSN, RN]

That's a very nice medical urban legend.

Yes, I was trying to internally give that physician the benefit of the doubt, but all I could come up with was "Nope, didn't happen."

I'm pretty sure lack of blood flow to the brain causes unconsciousness in SECONDS. Which means that as soon as he went into V-fib, he would have lost consciousness. And even the most effective CPR only provides a fraction of the blood flow to the organs that a normally beating heart would provide.

[MunoRN, RN]

I've dealt with a number of coding patients who are responsive during part or all of resuscitation. Good quality CPR can produce systolic blood pressures in the 80's or even 90's by art line, and a Lucas Device can sustain greater than 100 torr for an extended period of time. I've only seen this in patients where CPR is started immediately at the time of arrest, or where CPR is actually started before pulses are completely lost. It's basically the same thing that happens with a syncopal episode; the brain looses effective perfusion for a short time, in which case it's not unheard of for the patient to regain consciousness with the return of effective perfusion.

[Guest219794]

I am going to weigh in on the highly doubtful side.

Assuming one can survive 2 hours of CPR, there would be some documented cases of survival to discharge after 2 hours of compressions.

But, the part of the story where the guy gives a little nod is a great touch, and some say never let the truth get in the way of a good story. I say let the story stand.

[Emergent, RN]

There is literature and research out there regarding this. It DOES happen. Whether he was telling a big fish story or not, I'm not a mind reader, but he told the story straight.

He said that the patient would wake up whenever they restarted compressions.

Do a Google search on the subject.

[blondy2061h, MSN, RN]

I was in a code where a patient was beginning to gain consciousness during parts of it. It was nothing like your described, though. The patient was just opening their eyes for brief seconds and was awake enough to move their hands toward their groin where a line was being placed. He was clearly still by and large out of it.

[guest769224]

Yes it can happen.

I worked a code last year in ICU where every time I began CPR the patients eyes would jolt wide open and she would move her arms toward her chest to see what was causing such pressure. The instant we ceased CPR, she fell back to unconsciousness...as makes sense. This happened intermittently during the code that lasted 45 minutes. She did not make it

[offlabel]

Interesting if true...certainly more to the story.

[calivianya, BSN, RN]

Yes, I was trying to internally give that physician the benefit of the doubt, but all I could come up with was "Nope, didn't happen."

I'm pretty sure lack of blood flow to the brain causes unconsciousness in SECONDS. Which means that as soon as he went into V-fib, he would have lost consciousness. And even the most effective CPR only provides a fraction of the blood flow to the organs that a normally beating heart would provide.

You've never met my coworkers. We have this one who's a total gym rat who gives amazing compressions. I have watched a radial a-line that's still level with the heart read a systolic in the 150s when he's doing compressions. He can actually make a patient hypertensive during a code.

I had a coworker at my first job like that, too. It was just unbelievable watching him do compressions. He was ex-military and he was built like a tank - his arms were bigger around than my thighs.

Watching those freakishly strong men do compressions is an experience I highly recommend to any straight female. Just saying. (Psst... you ought to see the veins in the current gym rat coworker. He has veins in his thumbs bigger than what I have in my AC. His AC could take a cordis!)

On-topic - I have seen nonpurposeful movements and semi-arousable patients during a code, as previously described, but I have never had anyone follow commands during compressions. Not that I've been asking them to squeeze my hands or anything; it's usually a little too busy for that.