Patient responsive but in cardiac arrest

  1. 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:

    Has anyone else experienced this?
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    About Blandini7

    Joined: Feb '13; Posts: 14; Likes: 13
    Critical Care RN; from US
    Specialty: 16 year(s) of experience in Critical Care


  3. by   hwilliams1
    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.
  4. by   Blandini7
    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. by   Penelope_Pitstop
    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.
  6. by   merlee
    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
  7. by   Esme12
    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.
  8. by   detroitdano
    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.
  9. by   umcRN
    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
  10. by   Miiki
    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.
  11. by   HikingEDRN
    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!
  12. by   Mully
    Crazy! I never thought about this being a possibility.
  13. by   nursej22
    An elderly man admitted to our tele floor goes into ventricular standstill just as he arrives from ED. Compressions are started, man wakes up and starts yelling to be left alone, fighting off CPR. Compressions are stopped, he becomes non-responsive, restart compressions. He wakes up again, yelling stop, stop. This keeps up until they can get him hooked up to a percutaneous pacer, then off to the cath lab. His poor little wife is at the bedside, horrified.
    Of course, this is at 5 am, the fire alarm goes off, and a neurologist on the floor for a consult is stomping his feet because he can't find a chart and no one will pay attention to him. Gosh, I miss night shift, not!
  14. by   brandy1017
    There is a book out that talks about stuff like this Erasing Death by Dr Sam Parnia. Info is on NPR and was on the people's pharmacy radio show. Sounds very interesting and talks about the importance of CPR combined with hypothermia. While only a few people actually recall near death experiences where they see the light and God and their loved ones, he believes that everyone experiences this but that most have amnesia after the fact due to the trauma and inflammation of the brain from dying. Sounds like a good read!