Patient Conscious During CPR

[Emergent]

Amazing story told to me by an ER doc I work with. A patient he had, a fellow in his 30s, went into V-fib. Due to excellent CPR the patient was conscious throughout the code, which lasted almost 2 hours. They tried everything but could not bring back a rhythm.

He finally had to tell the man there was nothing else he could do, the guy gave a little nod and they let him go. He said it was the hardest thing he's had to do.

[guest769224]

You've never met my coworkers. We have this one who's a total gym rat who gives amazing compressions. I have watched a radial a-line that's still level with the heart read a systolic in the 150s when he's doing compressions. He can actually make a patient hypertensive during a code.

That isn't hard to do. My coworker and I watch to see if we can get the systolic reading on the A-line over 300 and at times we do (during compressions).

[akulahawkRN, ADN, RN, EMT-P]

I have also heard of this happening. It's actually not all that far-fetched. If the vasculature is able to maintain tone and the people doing CPR (or are using a Lucas) are able to maintain sufficient throughput, the brain will receive get good blood flow and therefore perfusion is maintained. What makes stories like this (and there are a very few of them) so touching is that while the person is under CPR, they're fully conscious and slip into unconsciousness when CPR stops only to reawaken when CPR restarts but because the heart won't maintain a viable rhythm and most places aren't set up to do crash ECMO, eventually efforts must cease and the patient has to be let go.

[Sun0408, ASN, RN]

Happened to me a few months ago. I was response that night and the pt went into vfib. Shortly after starting compressions she was fighting us but when we stopped she went u responsive again and vfib on the monitor!! She did survive the but I'm not sure if she left the hospital. Once she was in the ICU, my job was finished.

[Sun0408, ASN, RN]

Sorry!! I was rapid response that night. I forgot the rapid part lol

[Dogen]

I observed a code in which the patient opened his eyes, grabbed the hands of the person doing compressions, and made eye contact with her. Freaked everyone out for a second, and the RT doing compressions was creeped out for a week. He was an ICU pt with an EF of something like 20%, so the prevailing theory was that as he lost output over time his body had compensated in some way that allowed compressions to bring him around just enough to be confused. He wasn't responsive to questions, and tele didn't show signs of heart function. The intensivist running the code was skeptical enough that he brought in an ultrasound to visualize the heart before calling it.

[Been there,done that, ASN, RN]

Yes it can happen.

I worked a code last year in ICU where every time I began CPR the patients eyes would jolt wide open and she would move her arms toward her chest to see what was causing such pressure. The instant we ceased CPR, she fell back to unconsciousness...as makes sense. This happened intermittently during the code that lasted 45 minutes. She did not make it

30 years at the bedside, glad I missed that! .. thankfully that is not in my current repertoire of nightmares. Closest I came was a patient in v-tach.. gave him a thump and got thumped back.

[guest769224]

. Closest I came was a patient in v-tach.. gave him a thump and got thumped back.

You've performed a precordial thump? Fascinating. I've always wanted to witness that.

[Jensmom7, BSN, RN]

You've performed a precordial thump? Fascinating. I've always wanted to witness that.

Watch early episodes of ER. They did it all the time.

[meanmaryjean, DNP, RN]

Waaaaay back in the mid-80s, I worked an ED in Chicago. We had a 'CPR machine' that delivered compressions - pneumatically powered if I recall. We did have a patient who opened his eyes and tried to move while the machine was delivering compressions. We weren't able to get back a sustaining, perfusing rhythm.

[dream'n, BSN, RN]

Ugh, what a horrible way to go, conscience and aware while your body is assaulted. Where is my DNR paperwork??

[Jensmom7, BSN, RN]

Ugh what a horrible way to go, conscience and aware while your body is assaulted. Where is my DNR paperwork??[/quote']

I once thought about getting a "DNR" tattoo on my sternum.

[Glycerine82, LPN]

This is so random, but....

What happens after you do CPR and you're totally toast for the rest of your shift because you're wicked out of shape? That's gotta suck.

This story just makes me really sad, but it certainly seems plausible even if it's horrifying.