Patient responsive but in cardiac arrest

  1. 2
    I saw something this week in a code that is truly unique and a bit disturbing. We were doing CPR on a pt that coded and he started moving his arms purposefully. We stopped chest compressions and he was asystole and without a pulse. The ED doc that was running the code stated that he probably had enough cerebral perfusion during CPR to allow him to be responsive. I have seen this one other time (in my 14 years of critical care) but not as pronounced as in this case. Moral of the story, just because the pt is moving doesn't mean that spontaneous circulation has been restored.

    See link to abstract for more information: http://www.ncbi.nlm.nih.gov/pubmed/18483881

    Has anyone else experienced this?
    Esme12 and SoldierNurse22 like this.
  2. 32 Comments so far...

  3. 2
    I have seen it twice. Once was when I was an EMT on a rescue squad, we were doing CPR and the patient would actually sit up and start talking, we would obviously stop CPR and he would go back out. This went on until he was transported to the hospital. He did not survive, but we felt good about our rock star chest compressions. It was totally bizarre though.
    SoldierNurse22 and Blandini7 like this.
  4. 3
    Our pt did not survive either. This probably should be addressed in BLS courses so that responders aren't quick to cease compressions when the pt becomes responsive.
  5. 4
    Once, I was doing compressions on my patient, and she opened her eyes during them and LOOKED right at me with the saddest, most pained expression. It was horrifying. She should have never been a full code. She did survive the code but thankfully the family gathered and withdrew care after she had been in the unit for a day.

    My friend is an ED nurse and a man in full arrest arrived extremely hypothermic. As everyone waited for the warmed fluids and blood, et al., to do their jobs, CPR took hours and many, many rotation staff members. At one point, HE SAT STRAIGHT UP but then collapsed back.
    SummitRN, Blandini7, Lev <3, and 1 other like this.
  6. 2
    I have actually called 2 codes on pts that were AAO! One was about to go into anaphylactic shock - and would need to be intubated, the other was severely fluid overloaded and drowning. Both survived. In the first case, a doctor told me to just call the anesthesia office, to get someone to come up, but they wouldn't answer. The doc was pi$$ed when I called the code, but the code team was impressed that we didn't wait.

    The second person had rec'd 2 units of RBCs and plenty of saline, needed a diuretic and then more extreme measures.

    Too often, we do too little until it becomes a true emergency. I like the idea of a 'fast response' team, makes it easier to call prior to an arrest.
    Last edit by merlee on Sep 30, '13 : Reason: sp
    Blandini7 and gonzo1 like this.
  7. 1
    Thankfully only a couple of times.....I have had the patient open their eyes look at me or purposefully move...CREEPY! Funny neither patient survived either. It bothered me for a long time....I wondered what they knew...heard..did they know they were dying?

    Effective CPR leads to [perfusion....yes it is possible thank goodness it doesn't happen often.
    Blandini7 likes this.
  8. 3
    I had a patient wake up during CPR, start talking and then her vitals normalized. She was fine for about 10 minutes after that then arrested again and never came back. I'll never forget that. Really, really freaky to see someone wake up in a code.
    Blandini7, Lev <3, and Esme12 like this.
  9. 3
    Yes. Had a teen that kept going into complete heart block, we had difficulty getting his external pacer to capture and for a while he was too unstable to go to the OR for a permanent one. Unnerving to say the least.

    This patient survived
    Blandini7, Lev <3, and Esme12 like this.
  10. 3
    We had a GSW that seems like that. Every time we would start compressions, he would grab towards his chest. It later diminished to a shoulder shrug. Turns out that this was posturing and not the pt grabbing at us to stop compressions.
    daviltears, Blandini7, and Lev <3 like this.
  11. 2
    I have seen it. She was severely bradycardic upon arrival via EMS and on a nonrebreather. As we moved her from the EMS stretcher to our stretcher, eyes went up in the back of head and we lost the pulse. I started compressions and looked down at one point and she was looking up at me, like DeLana said, very reproachfully. I stopped, she would have a pulse for a little bit, and then go back out. This happened a couple of times. We kept her alive to get to the cath lab where I believe they placed a pacemaker. It turned out they think the cause was a high K (over 7).

    The next day I had to take 800 mg of motrin because my shoulders, upper back and chest muscles hurt like heck!
    Blandini7 and Lev <3 like this.


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