How long have you seen codes last?

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Specializes in NICU, Telephone Triage.

How long do the doctors on your unit take to call a code? What's the longest one you've seen? I am not comfortable usually after about 15-20 minutes of doing code drugs and compressions...how about you? How do you feel about coding a patient for 30 min. or longer?

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Specializes in Pulmonary.

First of all, the doctors are not the ones calling the code because they are usually not in the room. The nurses, PCT's are the ones I've usually seen calling the code. While the code is in progress the doctor arrives to intervene and gives orders maybe not in a code algorithm. The codes I've been involved with usually last max 1 1/2 hr, but there are cases where coding the patient goes on for hours. How I feel about coding a patient depends the patient's quality of life that pt will have after the code. I'm at a place where codes weigh heavy on my heart and I really hate being involved in a code if I have taken care of the patient. I know God has a plan for each of us, and having a relationship with Him gets me through tough times of the healthcare business.

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Specializes in OB/GYN, Peds, School Nurse, DD.
First of all, the doctors are not the ones calling the code because they are usually not in the room. The nurses, PCT's are the ones I've usually seen calling the code. While the code is in progress the doctor arrives to intervene and gives orders maybe not in a code algorithm. The codes I've been involved with usually last max 1 1/2 hr, but there are cases where coding the patient goes on for hours. How I feel about coding a patient depends the patient's quality of life that pt will have after the code. I'm at a place where codes weigh heavy on my heart and I really hate being involved in a code if I have taken care of the patient. I know God has a plan for each of us, and having a relationship with Him gets me through tough times of the healthcare business.

I think by "calling a code", she means "Calling the end of the code". The longest code I every participated in was about an hour. It was a child who had come in with flu-like symptoms on Friday,went into kidney failure, and coded on Sunday night. As long as I live I will never forget the feel of his little heart slowly stopping and starting under my hands. All of us were heart-broken when the doctor finally called it off. :crying2: He was 13.

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Specializes in Flight, ER, Transport, ICU/Critical Care.

I have been in 2 that went longer than 2 hours each.

1. Late 40's Male - Witnessed arrest at home, immediate CPR, EMS arrival and defib within 5, 1st perfusing rhythm in approx 40 minutes from time of arrest - In and Out of perfusing rhythm (Defib x 20+ overall) for hours. Person well known to ER and EMS staff, nobody wanted to stop - ultimately resus ended with sustained rhythm to cath lab, ICU stay unresponsive for 6 weeks. Woke in middle of off site prayer vigil totally INTACT save for eyesight (retinas sensitive to hypoxia). Amazing and humbling and traumatic for all - all were changed by participation.

2. One of my first few codes in medic school - 17 year old female had just delived healthy but small twin boys - uncontrollable hemmorhage requiring hysterectomy. Patient went into DIC and after dozens (40+) blood units, cryo, FFP and eyerything else ACLS - called code and we were all (15 or so had participated) crying (including OB doc) and standing in a massive pool of blood. It remains one of the most heartbreaking cases in my career.

Been in a couple of hypothermia that went way over an hour - you are not dead till you are WARM and dead.

Most of mine in the field or transport (ground - less than an hour) (air-maybe 15-20 minutes) and dependent on my geography. The rules for stopping are strict (as they should be) and the person stopping has to be MD (or with direct contact, field crew to MD) with the authority to pronounce death. A non-physician coroner would have no authority over my practice - the rules are very specific.

As a rule - warm, no immediate identifiable & reversable cause - it is a straightforward event. ABC's, maintain perfusion via compressions - electricity to convert arrthymia and drugs to stabilize myocardium.

As a medic - code starts and continues through transport (except in a few locations where on-line med control is contacted and termination decided after initial ACLS and sustained asystole) and MD then makes decision and if allowed a medic can stop. As a rule, codes are called after verfication that NOTHING remains to be done (1st line interventions, no potentially reversable cause, no treatable rhythm). Age of patient and mechanisms leading to the arrest are considered. Examples - 90ish in nursing home with unwitnessed arrest, found down and code started will be worked a bit different than a young person with penetrating trauma, initial vital signs and no massive external blood loss with a12 minute arrival into the care of a Level 1 trauma center.

There are so many variables - I have had very few instances of "bad docs" or unusual issues. Most every code I have been a part of all team members are valued and respected and agree to stop before efforts terminate. As for a TIME issue - I, too, am less optimistic after 20-30 minutes and like my first example, I have seen an extraordinary miracle event - so.....

This is the last ditch effort - and I will always err on the side of too much for too long than be left with doubts, questions or uncertanity that less than everything that could be done, was done.

I admit I have a different experience as I was a medic and ran most of "my" codes - so even as a new nurse, I was really "experienced" - I have had few triumphs and many "failures" - I admit there is a learning curve and the only thing that makes you experienced is experience and it is a difficult and stressful event at times. It never gets easy, but it does get different as you do it more often.

:angel:

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Specializes in ER.

Coded a person for over an hour on Christmas day :(

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Specializes in OB/GYN, Peds, School Nurse, DD.
Coded a person for over an hour on Christmas day :(

Oh man, that really sucks.:crying2:

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Specializes in Oncology.

2.5 hours. And the guy ended up walking out of the hospital a month later. It was a witnessed arrest and he was in asystole the whole time til he finally got a brady rhythm that we could pace up. The code went on so long cause the anesthesiologist kept yelling that he saw people who looked worse in PACU and this guy "just didn't look like he was dead." He even had us change out the monitor cause he didn't think there was any way it was asystole.

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Specializes in NICU, Telephone Triage.

Yes, by "calling the code" I meant at what time frame will the Dr. say to stop coding the pt. Wow, I am so amazed at the lengths of time each of you said you have coded a pt.! I also think about the quality of life that the pt. would have after the code. I had an issue with coding a very premature baby for almost an hour total. The Dr's do it because the parents want everything done, but at what price? 25 weeks is so small. I was told the baby even had bruises on it's chest from the compressions. Sometimes I feel we put these little ones through so much, then when they want to go, we still put them through more trauma until the very end. I know we have to do what the parents want, but it's so sad.

Thanks for all the stories, I couldn't imagine coding a person for 2.5 hrs!!!

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Specializes in Critical Care.

ICU here. We routinely have patients that are essentially in a "coding" state the entire shift. So sick we already have all the pressors maxed and will often pop in for a minute or two at a time to do compressions when the pulse weakens until the next amp of epi kicks in.

It goes without saying that such patients surviving the next 24 hours are rare.

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Specializes in Critical Care.
Coded a person for over an hour on Christmas day :(

Someone always codes on christmas. For the past couple years it's been like clockwork. Christmas and Thanksgiving you're going to get someone that codes (this is from an EMS perspective)

The longest I coded someone for was well over an hour, close to 2 actually. The guy wasn't sure whether he wanted to go towards the light or not. We made the decision for him.

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Specializes in Operating Room.
How long do the doctors on your unit take to call a code? What's the longest one you've seen? I am not comfortable usually after about 15-20 minutes of doing code drugs and compressions...how about you? How do you feel about coding a patient for 30 min. or longer?

We coded a 78 year old man in the OR for over an hour once..and he lived. Saw him in ICU a few days later smiling and talking with his family. It was pretty frickin' awesome.

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Specializes in Surgical, quality,management.

ran a code for an hour in a rural hospital by myself and the 2 ambos that had brought in the pt after working on her for over 1 1/2 hr in the field. Had the royal flying doctors rescue base doc on the phone. Called it after I stepped out of compressions and saw the lividity on the back of her neck. Those 2 ambos were exhausted and they knew the women being a small town where as I was the big city agency nurse that was only there for a few months. It was heart breaking her dad came in and developed chest pain from the shock. Was seriously thinking I would have to run a code on him as well in my other ED bed and I had no drugs left! TG I didn't have to but in all the families I have dealt with that is the first person who's heart I have seen literally break upon being told bad news. He just aged 20yrs in front of my eyes.

So an hour in the hospital and 1.5 in the field = 2 1/2 hrs.

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