I saw something this week in a code that is truly unique and a bit disturbing. We were doing CPR on a pt that coded and he started moving his arms purposefully. We stopped chest compressions and he was asystole and without a pulse. The ED doc that was running the code stated that he probably had enough cerebral perfusion during CPR to allow him to be responsive. I have seen this one other time (in my 14 years of critical care) but not as pronounced as in this case. Moral of the story, just because the pt is moving doesn't mean that spontaneous circulation has been restored.
There is a book out that talks about stuff like this Erasing Death by Dr Sam Parnia. Info is on NPR and was on the people's pharmacy radio show. Sounds very interesting and talks about the importance of CPR combined with hypothermia. While only a few people actually recall near death experiences where they see the light and God and their loved ones, he believes that everyone experiences this but that most have amnesia after the fact due to the trauma and inflammation of the brain from dying. Sounds like a good read!
It's quite possible for good quality CPR to perfuse the brain enough to support some level of consciousness, I've seen it many times and have had a few of these patients end up surviving. I have had to give versed to patients so they will tolerate CPR.
Specializes in Pediatrics/Developmental Pediatrics/Research/psych.
In ACLS, we covered a patient with asystole who is responsive. It could be an error in your monitor/ patient has an alternate mechanism for circulation. EKG only picks up ELECTRICAL activity of heart.
Definitely wasn't a loose lead or monitor error. Pt had no pulse by palpation, ultrasound, or doppler. The "alternate mechanism for circulation" was chest compressions.
I had a patient in 3rd degree block suddenly go into this weird, wide, S L O W Vtach. I thumped her, she yelled at me. Why did you hit me? Complained to her family, family complained to unit manager. Luckily all caught on monitor strips!
Specializes in Pediatrics/Developmental Pediatrics/Research/psych.
Obviously the thump worked.
Chest compressions only serve to continue perfusion during arrest. They don't work to "restart" the heart. Only defibrillation can restart a heart that is truly in asystole.
Of course, depending on other issues, in cases of dysrhythmias there are algorithms to be followed.
When I mentioned alternate methods, I was referring to a patient who's HEART doesn't pump by its own electrical stimulation. I forgot what this device is called
I hate to be a nitpicker(even though I'm pretty sure that's not a real word) but defibrillation doesn't "restart a heart that's in true asystole", reversing the cause does. Defibrillation (hopefully) restarts a heart that's in pulseless VT or VF.
That aside I have had one patient who would "come back to life" so to speak during compressions and pull at your hands on his chest, and would immediately go pulseless and unresponsive upon stopping compressions. Truly unsettling! He did not make it.
brandy1017, ASN, RN
2,910 Posts
There is a book out that talks about stuff like this Erasing Death by Dr Sam Parnia. Info is on NPR and was on the people's pharmacy radio show. Sounds very interesting and talks about the importance of CPR combined with hypothermia. While only a few people actually recall near death experiences where they see the light and God and their loved ones, he believes that everyone experiences this but that most have amnesia after the fact due to the trauma and inflammation of the brain from dying. Sounds like a good read!