AIUI, defibrillators are only used when the heart is beating out of rhythm. Drugs are used to restart a heart that has stopped.
A scene from Empire of the Sun has always made me wonder, so here’s my chance to ask. In the film a woman goes into cardiac arrest and someone tries to do CPR. At one point the woman’s eyes shift to apparently gaze on her putative savior. Will people experience intermittent episodes of consciousness during CPR as each surge of blood manages to reach the brain, or are they totally out until the heart can be restarted?
In my state there is a big difference in training, responsibility and authority between BLS (EMTs/First Aid) and ALS (paramedics). Paramedics have the authority to pronounce death under any circumstances. They are communication with a doctor both on the phone and via telemetry. The doctor approves the call but the paramedics make the call. In 25 years I never saw a doctor disagree with the paramedic on scene.
Here is the scene in question:
Note that the technique being performed in the scene is completely wrong and probably worse than useless. Hand placement is in the wrong position, the rescuer is just flexing his arms rather than performing straight-armed compressions of the chest, and the timing is wrong. Of course, an actor can’t perform real full stroke compressions without injuring the actor portraying the patient but there are ways to make it look more realistic. Also, in the WWII era context of the film, chest compressions like this are a complete anachronism. The appropriate historical way of trying to resuscitate a patient in cardiac arrest would be to raise and lower the arms (an almost complete ineffective technique which is no longer used), and closed chest compressions were not widely used even in professional emergency medicine until the 1960s.
As for a patient apparently regaining consciousness during CPR, it is certainly possible. This is unlikely to be actual full awareness of surroundings but a quasi-autonomic response due to adrenaline response or a burst of terminal brain activity just prior to death that causes the patient to briefly present as conscious, and has even been seen in decapitations and other unrecoverable traumatic injuries. Since consciousness is a subjective phenomenon (and is a very layered set of states rather than a gestalt on/off condition) it is difficult to really say whether a non-responsive patient might still be some degree of conscious during CPR or not.
Stranger
Yeah, I tried to hedge my statement by using “other machines” and “in defib” but it wasn’t the best way to phrase it.
In modern emergency rooms there is generally access to an ultrasound machine so you can directly check for heart activity which gives you a quick answer (especially if there was likely some delay before receiving any treatment). In practice, there seems to be no benefit in proceeding for more than fifteen minutes or going through the life support steps more than a couple times.
I have seen CPR and codes be successful many, many hundreds of times. Out of hospital survival rates are not always as high as one might like. But to the family and friends of those who recover, it made all the difference in the world.
As noted in the link, it doesn’t seem as good as standard CPR but it has shown to have some benefit, and it won’t make the patient more dead than they already are.
You generally needed to be in Advanced Cardiac Life Support (ACLS) classes to hear about it, in my experience anyway.
Most times I have called a halt to CPR were when it was shown they had no shockable rhythm and epi did nothing nor did the 2nd and 3rd line drugs, or had actual rigor mortis going on. Or the angle of the neck was such that it was incompatible with life (generally after suicide hangings).
OP here. I asked the question because this happened to my wife a couple of weeks ago. Fortunately she is recovering in ICU, and her prognosis is good for a complete recovery. We are so very fortunate.
Just under three weeks ago I had taken her to the emergency room because she was complaining of nausea. So we were already in the ER when her heart stopped. I was right beside her when it happened, and the medical staff allowed me to stay there. They brought in the LUCAS device (wiki link) and were doing chest compressions for three minutes. I was there to hold her hand to squeeze her shoulder or squeeze her leg depending on where I was as I tried to stay out of their way. After three minutes of chest compressions, thankfully her heart started.
Four hours later, still in the ER, her heart stopped again. I stayed beside her while they perform CPR for 20 minutes. Again I was squeezing her and whispering in her ear or otherwise talking to her as they were performing CPR. Telling her to fight. Throughout this, on some level, I knew I was communicating to her both verbally and with my touch and squeezing.
During those times of CPR the medical staff was calling out vitals or statistics or certain levels of her blood chemistry, whatever it was I’m not sure, and it was amazing as they administered meds based on her current status at that very moment. The wonders of modern medicine! I really didn’t pay close attention to what they were saying or doing. Other than I knew they were performing CPR and responding to her heart stoppage. I just wanted to be there for her, and I wanted her to know she wasn’t alone.
There was never any defib.
Fortunately, thankfully, so gratefully, she came back to life. She has since had two emergency surgeries, and as I said earlier she’s been in ICU for about three weeks since this happened. She’s getting stronger, and from our conversations it appears that there’s been no brain damage at all. Fantastic! She’s just starting to walk now. And they are planning to transfer her out of ICU.
Miraculously, we’re looking at a full recovery.
So in retrospect I was wondering about the 20 minutes of CPR, and when if her heart never restarted they would simply pronounce her dead. And that’s why I asked the question in the OP. I found an NIH article that generally says that about 30 minutes of CPR is typically the most that is usually done, or commonly done. After 30 minutes the chances of recovery drop dramatically. But there are so many variables, so many different situations and circumstances, that you can’t always have a definitive time limit for all situations. As we’ve been discussing here
25 years in the ER,
Quick answer:
5 to 30 covers most cases, 0 to 60 covers almost all cases, depending on variables.
Variables include:
age of pt, precipitating events, pre-existing conditions, pre-hospital care, wishes of pt and on scene family, individual Dr’s standards. That last is a fairly minor variation.
Details on request, but I’m off too work.
Congratulations on your wife’s recovery, Bullitt. I’m so sorry you and she had to go through that, but very, very glad for such a positive outcome.
To the best of my knowledge, patients don’t regain any level of consciousness intermittently, in time with the compressions - no more than our normal consciousness has any variations in time with our heart beat.
As to regaining consciousness during CPR, it’s rare, but does happen. I can’t speak to how fully aware such patients are. My personal experience only extends to a couple such incidents.
Out of the many cardiac arrests I’ve worked, one patient opened his eyes and seemed to be looking around. Another did that as well as weakly reaching up with both hands toward my hands on his chest. Both were intubated, so speech wasn’t a possibility.
This is where critical care medicine really is coming to shine in the last couple of decades; up to the minute (or even the second) analysis of hypercritical conditions, along with the ability to rapidly correct dangerously high or low levels of vital substances like potassium, calcium, sodium, plasma, red cells and more. I’m too far removed from ER work (1980 thru 1990) to have seen it firsthand, but I remember my frustration with it taking too long to get useful labs back and the promise of more rapid results.
I’m very happy to hear your wife is recovering; we in the medical fields love hearing about those success stories. All the best to her and you!
After writing an answer, it occurred to me the only time I have seen CPR successful after fifteen minutes was an unusual case of hypothermia. This is a well known exception.
You’re not dead until you’re warm and dead.
I am so happy for you both!
As I’ve recounted in other threads, I arrested seven years ago. I was luckily already in the ER by the time that happened and was being attended by a cardiac arrest specialist. They performed both CPR and defibrillation, but I don’t think for very long (I don’t know for sure, because I wasn’t “there”). I arrested a second time on the way to the cath lab and was resuscitated quickly (I think) in the hallway.
Like you, my wife was there the whole time. She has developed significant anxiety as a direct result of having to watch that. I urge you, while looking after your wife, to take care of yourself.
I can’t even image being through that with a loved one. The Lucas is scary when you first see it when you aren’t emotionally involved with the patient. There is only one thing more disturbing and that’s when they pull out a drill and do Intraosseous infusion. I was pushing on someone’s chest the first time I saw that and I was like “What the fuck.”
A bit off topic but… I’ve been a CPR instructor for 15 years but have never performed (or even witnessed) CPR being done. A pre-requisite of me showing up was the person was dead. I heard the NPR story linked above several weeks ago. It wasn’t very encouraging regarding the chances of complications-free success. I already knew the “make it to the hospital” odds but the guest was pretty clear that most of the people who got that far (85%?) has serious long term problems. Better than being dead? Maybe, maybe not.
On the other hand, a co-worker arrested at home a while back. He had to be shocked twice in the ambulance on once in the ED. He is completely fine today. He had everything going for him. He is obsessed with fitness and diet and has been his whole life. Evidently, you can’t exercise genetics away. The arrest was witnessed the the firehouse is less than 1/2 mile away.
In any case, you would not believe the bureaucracy involved with the American Heart Association and training CPR. It is a industry unto itself. Every five years they come out with new standards and, of course, you have to buy all new material or equipment each time. CPR, at its core, is really quite
simple. It doesn’t take eight hours of watching training videos to get it.
Right then and there, in those moments, we do what needs to be done. I held it together and was calm, and was glad they wanted me to be there with her. It wasn’t until late the night after she was revived and when she was in emergency surgery that I broke down and cried.
As for Lucas, I was actually a little fascinated by it. The automation meant the compressions were measured and consistent. I dunno, my entire career after the Marine Corps was in medical device development so maybe that’s why, to me, it was kind of cool.
What the fuck is right. I’m glad they never did that.
Today it looks like there’s 90% chance my wife will be discharged and coming home! I just want to hold her and never let go.
She just got discharged!
Congratulations! I’m glad she’s okay, and although you say you just did what was necessary at the time, I’ve seen enough family members absolutely lose their minds during emergencies of much lesser import. It’s praiseworthy that you kept your head and were able to support your wife.