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.

[tcvnurse, BSN, RN]

In our facility the ACLS instructor likes to say, "Push hard, push fast, don't stop pushing till they wake up and tell you to stop."

I gave compressions one time, and every time the guys would wake back up after about twenty seconds of CPR, and immediately DIE again when I stopped. It freaked me out bad. Talked to some of the more experienced ICU nurses at the time--turns out that just happens from time to time.

[OyWithThePoodles, RN]

I have NO upper body strength. I'm talking-those puppies get tired when I fix my hair! That being said...

The one time I personally had to give compressions was when the recipient was on the ground, I had my full body weight behind me. My husband was the only other person there that could help and he switched out twice. We did 10 minutes of CPR before we got a pulse back.

I was not tired in the least afterward. The adrenaline kicked in.

NOW... The next day, my knees were super sore from giving CPR on gravel and my legs felt like jello. But my arms were only very mildly sore.

If I ever have to give compressions in a hospital setting I can assure you I will tire quickly, the bed would be stomach height meaning I would be using mostly arm strength (ha) as opposed to body weight.

[Guest219794]

For folks who have done a successful precordial thump:

I have done it once- v-tach, no pads on, doc yelled "preordial thump!". Having seen this in the movies, I wound up and thumped him. It did not work, but we did defibrillate him, then twice more on the way to the cath lab. Each time he woke up, he complained his chest hurt.

So- how hard? I just guessed and walloped him. I asked all my peers,none had done it, or had an idea of how.

[kalycat, BSN, RN]

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.

This happened to me. My first code on the floor after leaving the OR - a very young adult transplant patient. It was sudden and unexpected - happened as I was walking by the door to the room. I heard a scream, the patient brady'd down to 30, went unresponsive, we lost a pulse. I was the first on the chest. After two rounds of compressions, the patient's eyes flew open and they reached out and weakly grabbed my arm with both hands while I was doing compressions. As we stopped for a pulse check, the patient went unresponsive again.

I clearly remember resuming compressions and feeling those broken ribs. We never achieved ROSC after working for 90 minutes. I shocked someone in the OR who didn't respond to Versed and was pretty awake - this CPR incident was a lot harder to deal with.

I'm not bothered by much but that definitely kept me up at night for a bit. The story overall was an utter tragedy of teen rebellion, experimentation, and non-compliance with care despite being a transplant recipient. The code itself ended up being quite graphic.

I carry that one with me.

[calivianya, BSN, RN]

This really shouldn't happen. I'm over 60 and overweight. I've also taught CPR since 1977. The secret is to always keep your shoulders directly above your hands, and let your body weight do the work. I can do compressions for quite a while before needing relief. Most people make the mistake of having their HEAD above their hands (so they can 'see what they're doing'). Your head should be looking at the surface on the other side of the patient and your shoulders above your hands for maximum efficiency. It's physics kids- visualize a piston!

The problem is I'm just not tall enough. I'm 5'4". Even with the bed at the lowest setting, it's impossible for me to get over the patient to the point that my shoulders are directly over my hands. The bed only goes down to my hip height and its pretty wide, so with the patient in the middle of the bed I'm having to lean over to get to the center of the patient's chest with my hands.

I suppose I really should be getting in the bed with the patient, but I'm pretty leery of that with all of the substances that can fountain out of a patient's mouth during compressions if there's anything of the obstruction/ileus/esophageal varices nature going on that we don't know about yet...

[kalycat, BSN, RN]

Calivianya, I'm short too. (5' 1" and top heavy) I usually try to use my upper body as much as possible as MMJ described, but you're right, it's hard!

I did 9 rounds (not in a row) of compressions one time with the side rail up and in the way!! It was sort of chaotic and no one could get in position to drop the side rail due to copious flying fluids. After that event, I spent 3 days at home on a heating pad. My lower back felt like someone had beat me with a baseball bat!

[AnnieOaklyRN, BSN, RN, EMT-P]

Actually a few of the automated CPR devices DO actually do such good CPR there have been a handful of patients that have woken up during CPR and needed sedation. It is not a myth or legend! I have heard of this happening several times with the Lucas Device that our ER uses! Manual CPR very doubtful however!

Annie

[pcicurn7]

Definitely not a myth. I actually like to glance at the arterial line waveform to see if my compressions are generating good perfusion. And I'm 5'1....it's all about technique. I hop on the bed, lol.

[NotReady4PrimeTime, RN]

Our PICU has stools strategically placed around the unit for people to stand on during CPR. (We also use them to reach our monitors, which are hung in the absolutely worst possible position over the 45° HOB and smack in the middle between the double IV pole and the ventilator...) Our cribs don't have height-adjustable mattresses so we have no choice for crib-sized kiddos.

I had a patient arrest on me after the longest echo in history. As long as she was being bugged, she had enough endogenous catecholamine circulating to keep her going, but as soon as the echo was over and the resident was on the phone with the attending, she brady-ed right down. I saw it coming and got help and the cart into the room so she got CPR before pulses were gone. She would start moving during compressions and go limp during pulse checks too. We were in the middle of deploying ECPR when the surgeon asked me to give her some rocuronium because she was trying to roll over. I would call BS too if I hadn't seen it with my own eyes. She not only survived but had her heart repaired and is an active preschooler now.

[WoosahRN, MSN, RN]

Not sure about the details in the original post but picu nurse here and heard from many coworkers about an experience where a teenager in our cvicu went into an arrhythmia needing CPR and was fighting them and trying to push them off of her. Very disturbing. Until that situation I hadn't realized it was possible for the patient to be alert during compressions but I guess it makes sense if they're started immediately and done well. I'm sure it hurts like hell.