10 year old died after I performed CPR

[MjHudd]

This is my first post after many years of reading allnurses posts written by others. I'll give a brief background on myself... I've been an RN for 11 years, working in both the OR and home health. I never had any interest in critical care nursing as I know how sensitive I am and that I would likely not be able to cope with amount of loss associated with critical care. With that said, I'm having a hard time coming to terms with my grief over a recent incident that occurred outside of work and I'm hoping someone can offer some advice.

Six days ago, I was visiting my cousin and her new baby at their home. We were sitting in her living room, which overlooks her backyard as well as the backyard of her neighbor. Her neighbor has a large inground pool and there were 4 children (teens) playing and swimming around the pool while an older woman sat and watched them. At one point I glanced out the window and noticed that the older woman appeared to be attempting chest compressions on one of the children who was laying on the ground but she obviously didn't know CPR and was frantically screaming for someone to help her. I took off out of my cousins home, jumped over the fence between the two yards and began assessing the young boy. He was not breathing and had no pulse so I immediately began CPR. Between breaths, while doing chest compressions, I attempted to gather information from the woman, who turned out to be the boy's grandmother.

Me: "What happened? Did you call 911?"

Grandmother: "I don't know! He said he couldn't breathe and then just collapsed! Yes I called"

Me: "Any health problems?"

Grandmother: "He had heart surgery when he was born but he's been fine since then!"

Me: "How old is he?"

Grandmother: "10"

And so on... After a couple of minutes of CPR, the boy took a few shallow breathes on his own and I was able to feel a weak pulse. I rolled him onto his side hopeful he would regain consciousness but as soon as I did this, his breathing and pulse stopped. I then resumed CPR until EMTs arrived about 10-15 minutes later. I stayed with the family for about 30 minutes after the ambulance left, attempting to comfort the other children that were present- his 13 year old sister and 13 & 15 year old male cousins. The boy's aunt arrived at the house just before the ambulance left and was also comforting her sons and niece. I left my phone number with the aunt and asked her if she could update me on his condition when she knew more which she promised to do. I then returned to my cousin's home briefly before heading home. Later that evening, I got a call from the boy's aunt informing me that the boy never regained consciousness and died in the ER. I offered my heartfelt condolences and my support in any way needed. When I hung up the phone, I fell apart, sobbing uncontrollably for a long time. I felt like a failure- even though I know that's not a logical reaction. And now, 6 days later, I can't seem to let this go. I think about it constantly and wonder if I could've done more or done something differently. I really want to reach out to his family but I'm not sure if I should. I would like to know if there was an underlying cause of death that was beyond my control. I want to know if his sister is ok and the other 2 boys that were there. I would like to meet his mother and father since they weren't at the scene and tell them how sorry I am that I couldn't save their baby.... I just want to be at peace with this but I don't know how.

[Ndy-RN]

Oh dear[emoji22]so sorry!

[blondy2061h, MSN, RN]

Oh no! What a horrible thing for all parties to be involved with! I'm so sorry to hear you had to go through this.

I am going to make one slight edit to your title. "A 10 year old boy died, and your CPR didn't reverse that."

If he needed CPR he had died. Unfortunately, our resuscitation techniques aren't perfect.

[JustBeachyNurse, LPN]

He was dead when you started. You did not fail him, CPR wasn't enough to restart his heart. While you are curious; the why is irrelevant. The family may not consent to an autopsy depending on his history.

You saw a problem and you tried to help. You FIRST asked if 911 was called which was the most important step as clearly he needed more than CPR.

Since this was not a professional relationship but Good Samaritan watch for the obituary to be posted. If the services are public, feel free to seek closure by offering your condolences to the family. Don't say I'm sorry my CPR didn't work it's likely the aunt & grandmother will identify & introduce you. Without knowing the history, it's likely the parents will be thankful you tried to help.

If the services are private, then you can send your condolences via the funeral home. Tell the funeral director that if the parents wish to contact you they may this way it's on the parents terms not your need for closure. I've seen traumatic pediatric deaths go both ways. Open/public services and closed/private services. It's impossible to predict.

[Libby1987]

I don't have any words of wisdom, just want to extend my sympathy, it would so hard to shake such an experience.

Even though he couldn't be saved, you did ease some of the shock and trauma for the family by taking over and not leaving them completely helpless for the longest 15 minutes of their lives.

[JaxJax5423]

kudos to you for springing into action. I can understand your feelings, but please know you did the best you could. I'm sure the family is greatful for that. Does your place of employment offer a chaplain or grief counseling?

[Wuzzie]

And now, 6 days later, I can't seem to let this go. I think about it constantly and wonder if I could've done more or done something differently. I really want to reach out to his family but I'm not sure if I should. I would like to know if there was an underlying cause of death that was beyond my control. I want to know if his sister is ok and the other 2 boys that were there. I would like to meet his mother and father since they weren't at the scene and tell them how sorry I am that I couldn't save their baby.... I just want to be at peace with this but I don't know how.

All of your feelings are normal responses to what you have been through. When we have events like this in the hospital we have a process in place to give the involved staff members an opportunity to de-stress called a Critical Incident Stress De-Briefing (CISD). As a private citizen I encourage you to utilize your employer's EAP program and do it soon. This is not something that should be put off as there are frequently unexpected consequences when a person suffers an emotional trauma such as this. The EAP staff can help you process what happened and make good choices to take care of yourself. I can't stress enough how important it is for you to do this.

As far as contacting the family. At this point, as much as you'd like to, this is not a good idea. For either of you. If the family wants contact with you they will reach out. Until then it's best to just stay out of their grief for the time being and deal with your own emotions.

[Wuzzie]

Since this was not a professional relationship but Good Samaritan watch for the obituary to be posted. If the services are public, feel free to seek closure by offering your condolences to the family. Don't say I'm sorry my CPR didn't work it's likely the aunt & grandmother will identify & introduce you. Without knowing the history, it's likely the parents will be thankful you tried to help.

The only thing I worry about with this is that sometimes the parents actually act in the complete opposite way and become very, very angry and blame the people who could not save the child. This would have dreadful consequences for the OP. I always recommend waiting for the family to reach out and they may never want to.

[Here.I.Stand, BSN, RN]

((((Hugs)))) Your efforts did not fail him -- he was gone. I know you know that, but want you to "hear" it from an unbiased 3rd party.

I agree with the other posters that you should leave the family alone at this point. The grandma has your contact info, so if they want to take the initiative, they can. They may not want to, which is their right. They may feel that would be reliving their trauma.

Underlying condition or no, this boy was gone. You kept circulation going, which was what he needed, but remember neither EMS nor the ED staff could save him either. There was nothing you could have done.

[JustBeachyNurse, LPN]

((((Hugs)))) Your efforts did not fail him -- he was gone. I know you know that, but want you to "hear" it from an unbiased 3rd party.

I agree with the other posters that you should leave the family alone at this point. The grandma has your contact info, so if they want to take the initiative, they can. They may not want to, which is their right. They may feel that would be reliving their trauma.

Underlying condition or no, this boy was gone. You kept circulation going, which was what he needed, but remember neither EMS nor the ED staff could save him either. There was nothing you could have done.

^^^better advice. You can send simple condolences to the funeral home but not explain your role.

The family has your contact info. If they wish to reach out it must be on their terms

[emmy27]

Most CPR is not successful. I know you probably know already know that intellectually, but since you report working in areas where it's uncommon to perform it, you probably have not seen it often enough to truly internalize that truth. Movie and tv CPR is nearly always successful, so many people, even health care professionals, feel on a gut level like if only it's done properly, CPR will always bring someone back, and not just back, but back to their original state of health and function.

In reality, only a small fraction of CPR patients achieve ROSC, and an even smaller percentage of those survive any length of time with any quality of life after that. It is a last-ditch effort to save someone who is otherwise already dead.

In performing high-quality CPR when no one else present knew how, you gave this child his best chance at survival. That it wasn't to be is not your fault- it's the reality of death, which is only very rarely reversible. Hopefully, with time, it will give you and the boy's family consolation to know that his death was not due to a lack of effort or the fact that no one present could give CPR.

I imagine the grandmother's guilt and sorrow over not knowing what to do has been eased by the fact that someone else present did know. Thanks to your efforts, she does not have to live with the terrible "what if" of wondering if her knowing CPR could have saved him. It could not. There is also ample evidence that families who witness CPR efforts have lower rates of depression, anxiety, and PTSD as they grieve than families who were not present. Although his parents did not witness your efforts, his grandmother did, and I think it's not unreasonable to extrapolate from these findings that having more information about how hard others tried to save their loved one is psychologically helpful to survivors in the long run, and that knowing a nurse was present and tried her best to save him may be a source of comfort to the family.

I agree that you should not try to contact the family, and that you should seek a few sessions with a counselor through EAP. Vicarious trauma and grief can have serious consequences, and talking it out with a professional can be enormously helpful. You did your best to take care of this boy, now it is time to take care of yourself.

[FranEMTnurse, CNA, LPN, EMT-I]

Oh my dear, I feel so bad for you. what a horrible experience. I know you will never forget this, but if it's any comfort to you at all, I know you did your level best in this case. You are a very kind, caring helpful nurse. God bless you.