Good outcomes after prolonged CPR?

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Specializes in ER.

So has anyone ever had a good outcome after doing CPR greater than 25 minutes or doing CPR multiple times with return to spontaneous circulation that lasts for just a few minutes before going away? A good outcome as in you know the patient survived to get discharged from the hospital?

We coded a girl for about 2 hours with just brief return to rosc 4 times but she coded quickly after. In two entries, the scribe did not even change the times for the return and the loss.

I don't mean to be mean, but I feel like we did a huge disservice to this woman. I feel like the nurses and the resident were too attached in the emotional terms of she's the same age as me or she's younger than me. However, she had health problems we'd see in people 20 to 30 years older than her. One of the newer nurse kept on saying "in theory, the best chest compressions should perfuse the brain."

On the squad, we've had poor outcomes but "good saves." We had supplies available to us that this hospital doesn't even have. Our ice protocol is a better ice protocol. To be honest, if I had a heart attack I would feel safer having them run a code out in the field than having it in this ER because they have access to more advanced. However we buy them days.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Man...that's tough...once or twice. I consider those miracles and they are far and few between. The ones I that really bothered me were kids...coding them praying to get them back and then realizing...what did we bring back.

It stinks.

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Specializes in Emergency & Trauma/Adult ICU.

A couple of thoughts about your post:

25 minutes is not an unusual length of time to run a code. Nor has it been unusual in my ED and ICU experience to code a patient multiple times. And there are a few of my patients with this history out there in essentially the same condition as they were pre-cardiac arrest.

There is research out there on post-resuscitation outcomes - you can do a literature search. A better indicator than total length of resuscitative efforts is ... what happens in the FIRST minutes after cardiac arrest. Immediate chest compressions, early defibrillation, etc. That's why this part of your post bothers me:

One of the newer nurse kept on saying "in theory, the best chest compressions should perfuse the brain."

That's not theory ... that's physiological fact. Compressions NEED to produce perfusion, as evidenced by a palpable pulse. Perhaps your ED could partner with a local EMS service which may have some training materials, electronic manikins, etc. for the next round of CPR renewal - so that all participants can get feedback on the quality of their compressions.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

I've seen one awesome outcome -- young soldier, found down in his room (I think someone heard him fall), immediate CPR, worked him quite a while in the ED (like, 45 minutes), finally got him back, shipped him out. Some months later he came back to thank us, walking and talking, with his parents. A freakin' miracle. He has some memory deficits, but is otherwise okay. Not sure what the cause was of his arrest, but we all got a little teary when he came in, even our crusty ol' ER doc who has been at it for 30+ years. It doesn't get any better than that.

And honestly, unless they've bled out upon arrival or are in rigor, why not go a bit longer than 25 minutes? Because ... see above.

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Specializes in ER.

It's 25 minutes, rosc less than 5 minutes, 20 minutes, rosc less than 5, 35 minutes, rosc same line, 35, etc. I noticed in some of the charting the weak pulse felt and then pulse no longer felt in the same entry. The recorder didn't even bother to add another time slot because of how short between the pulse and the pulse was gone. I do think that they felt they had a pulse back longer in the heat of the moment.

As for your multiple codes in a short time frame, did you follow them long term? Find out how they were when they were discharged? It seems like a lot of people think "heart beat! Yay we saved the person!" How short was the time between the CPR paused and the heart beat no longer detectable and resuming CPR? I''m referring to a time frame of where you wouldn't even be able to package them to go.

Even the medical director said the code carried on way too long given her issues when he saw the chart after they talked about it. He told the new nurse that the patient was not a normal, healthy "age."

If the attending hadn't stepped in, we would have continued on. I think I may be missing a round of CPR in there. Pretty much we cleaned 2 crash carts and the accudose of epi. I think they also mixed a vial of epi in prep too.

I really do feel that the CPR continued too long because they wanted the save because of the age.

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Specializes in NICU, ICU, PICU, Academia.

The only prolonged CPR/ good outcome I am personally familiar with was an infant trapped in a vehicle, submerged in a cold stream. 45 minutes of CPR AFTER 20 minutes in the water. Is now a happy, healthy middle-schooler.

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Specializes in Oncology, Ortho/trauma,.

I once read that on any given cpr only 12% survive and only 3% of that 12 return to completely normal function.

Maybe this article might help

# 179 CPR Survival in the Hospital Setting

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Specializes in NRP, FP-C, CCP-C, CCEMT-P.

A little something for you to read and might find interesting.......

96-Minute CPR Marathon Saves Minnesota Man's Life - ABC News

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