I have noticed during my short time as an ED nurse that many of the cardiac arrest cases that come in through my ED (while I was on shift) seemed to be a waste. I've never seen anyone achieve ROSC that had a chance of actually recovering meaningful function (more seasoned staff saying they may die in ICU or live out their lives in a "vent farm"). Maybe some of the patients may recover, but they certainly never woke up after CPR.
There was a trauma case that came in a very severe car accident and the person was already in cardiac arrest when they rolled in and we spent at least 30 to 40 minutes trying to save this guy. He must have got like 8 units of blood and died anyway.
I feel like sometimes my efforts and the efforts of the team are wasted and that we should have stopped sooner.
Are you using hypothermia s/p ROSC? As a CCU/ICU nurse, that seemed to be a turning point in how many were walking out instead of becoming vent dependent with other anoxic brain injury insults. I used to do private duty for a disabled teen who survived two codes due to LQTS. I wish hypothermia had been available for him.
I know ER has many codes, long and short that never make it to the units. But of the ones who did, I saw quite a few walk out. Especially the cooled ones (and some of that might simply be that be meeting the criteria to to be cooled in the first place indicated a greater chance.
One of the most memorable walk outs was actually a man who lived down the street from me. He was lucky enough to collapse in front of a co-worker who had just taken a CPR recert. He was lucky enough to work 3 blocks from EMS, who were in station and 1/2 mile from our hospital. After ROSC, he went to the lab, had occlusions opened, IABP started and sent up with swann showing poor to fair numbers. Cooling went by schedule though and he was waking meaningfully after rewarming. Kept sedated for vent and balloon until weaned. Step down and ambulating one week post-code. Tragically, he collapsed again at home 12 months later and didn't make it. But those 12 months? He saw his daughter get engaged, his son and their car race another season, his foster son start picking colleges and play another season of football, he made cookies with his children and their partners, his foster kids, and my daughter, he worked, and he cuddled his dogs.
'Hypothermia' as a post-arrest treatment doesn't really exist anymore, there is no evidence and actually never was any evidence that induced hypothermia produces better neurological outcomes than normothermia, more recent studies comparing hypothermia to 'targeted temperature management' with normothermia as the goal found no benefit to hypothermia over normothermia, but did find an increase in adverse events due to induced hypothermia.
Post-arrest hypothermia treatment was definitely over-hyped when it first came out, I think many were under the impression that it could somehow reverse anoxic injury that occurred during an arrest, when really all it can do is prevent further anoxic injury in the period after ROSC.
Post-arrest hypothermia treatment was definitely over-hyped when it first came out, I think many were under the impression that it could somehow reverse anoxic injury that occurred during an arrest, when really all it can do is prevent further anoxic injury in the period after ROSC.
But I bet that Arctic Sun company made a lot of cash while the gettin' was good!
Funny I just renewed my ACLS...according to AHA, post arrest hypothermia (which they now call targeted temperature therapy) is still in the post-rosc algorithm.
Funny I just renewed my ACLS...according to AHA, post arrest hypothermia (which they now call targeted temperature therapy) is still in the post-rosc algorithm.
Therapeutic hypothermia (goal temp 32-34) was replaced by Targeted Temperature Management, they are two different things, not the same thing with a different name. TTM has a cooling goal of 36 degrees.
One time I was assigned in the CTICU and took care of a suicide male in his late 30's who gashed open his wrists, bilateral carotids, stabbed himself in the abdomen several times. He was in the ICU for several weeks for post-op recovery. When I had him, he had 3 chest tubes, trache and on ventilator but minimal sedation, awake, alert, and responsive. Several wounds on his wrists and neck were gigantic. Plastics was involved as well. I had him for 2 nights in a row. On my 2nd night I was with him he was watching an old western movie which I watched with him briefly while I was in his room and we both shared a few comments about the movie. After my shift was over, I never saw him again. (I work as an agency RN at this hospital.)
Fast forward a year later, I was working at my current Freestanding ED. A 10 year old girl had been signed up for abdominal pain. While she was being triaged, I heard my name called out from a gentleman in triage with this little girl. He waved at me, called out my name and asked how I was doing. Perplexed at who this gentleman could be, I just waved back and answered "I'm doing fine."
He waves at me to come meet his daughter so I approached him. I guess he notices that I don't seem to recognize him so he shows me his neck and wrists scars as well as his abdominal scars on his abdomen. Only then do I recall this person. He recounts everything about our interaction during his stay in the ICU, he also mentions about the old western movie I was watching with him and the trache care I provided him, etc. I was so amazed at his recovery.
As I was discharging his daughter after feeling better, she thanked me for taking care of her. I told her I once also cared for her dad, at which she looked at her dad and smiled.
I could only imagine what he went through during his arrival in the ED a year prior. I guess that ONE life that's saved can make a difference.
I totally understand what the OP means but a few weeks ago we had a cardiac arrest come in and we got the guy back, got him to cath lab and he was extubated a few weeks later and doing well. It's moments like that when we celebrate the wins, because they do happen.
Specializes in ED, Cardiac-step down, tele, med surg.
Yes, moments like that do happen, to actually save a life of a person to make a meaningful recovery. There was a patient a few days ago that came through our ED, full arrest, got pulses back EKG showed STEMI. She re arrested twice, we finally got her off to cath lab. She died later (found out last week).
Specializes in ED, Cardiac-step down, tele, med surg.
I get discouraged sometimes when my efforts fail to give the desired result, but the cases presented here have given me a more hopeful approach. Everyone deserves a chance to beat the odds, and that's what we try to do, provide the right circumstances so that our patients might beat the odds. Some of them do and other's do not. I just enjoy feeling like I really helped someone rather than prolong suffering.
MunoRN, RN
8,058 Posts
'Hypothermia' as a post-arrest treatment doesn't really exist anymore, there is no evidence and actually never was any evidence that induced hypothermia produces better neurological outcomes than normothermia, more recent studies comparing hypothermia to 'targeted temperature management' with normothermia as the goal found no benefit to hypothermia over normothermia, but did find an increase in adverse events due to induced hypothermia.
Post-arrest hypothermia treatment was definitely over-hyped when it first came out, I think many were under the impression that it could somehow reverse anoxic injury that occurred during an arrest, when really all it can do is prevent further anoxic injury in the period after ROSC.