Don't Quit - CPR 96 Minutes = Still alive

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catskills

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NPR: When Not To Quit: Man Revived After 96 Minutes

As a volunteer EMT-B I personally have had a few saves that were similar. Maybe not 96 minutes but 30+ minutes and revived in the hospital. One of the 52 YO patients that made it did give us some added incentive when during CPR en route to the hospital when I asked her by name if she can hear me blink twice and she blinked twice all while not having a heart rhythm that would not sustain life. That added incentive helps EMS. I could see where having the CO2 indicator would provide added incentive to EMS personnel. Then again we have a job to do and we should not need the incentive right.

We have all worked codes where you say to yourself this person is not going to make it. You say to yourself he/she has been down too long. But hey you never know.
 
Smash

Smash

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Well, despite the story being old, I'll bite:
What is the cutoff? If we can all have warm and fuzzy feelings after 96 minutes, what about 106? 2 hours? Indefinitely?

What's the rest of the story? How bad was the patient's hypothermia? Why only 12 defibrillations in over 1 and a half hours of alleged resuscitation? There is clearly more to this story then meets the eye.
 
akflightmedic

akflightmedic

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LOL...despite the doctor terminating the care, the nurse and emergency staff persisted. They just knew...

Doctors Schmocktors...who needs them!
 
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catskills

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When to Quit

I had the same questions.

I guess we need a follow up article on

When is it Time to Quit CPR
 
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usalsfyre

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Basing practice off of one anecdotal case is poor medicine.
 
sir.shocksalot

sir.shocksalot

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catskills said:
Good point. We need more data collected on saves from nurses and medics that ignored doctors when they tell everyone its time to stop.
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Good luck with that. Personally, I'm not wasting 96 minutes of my time trying to resuscitate a celery stick. Unless it's frozen, and then it's only because my medical director would be mad if I didn't try.

As I side note I like the part that says: "But one of the flight nurses who had come with the emergency helicopter had been trained in capnography." Is the author implying that none of the doctors know how to use it? Furthermore, why did the flight team transport a cardiac arrest? I have never seen a helicopter transport a cardiac arrest unless it happened while in transit. I dunno, this all seems a bit odd.
 
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DESERTDOC

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The NPR article is poorly written, or there are some glaring problems with the flow of patient care.

From the article "Emergency room doctors thought he was dead. But first responders who gave CPR on the scene decided not to give up, in part because of technology that allowed them to see their efforts were working."

The man was dead, period end of story.

The article states "But one of the flight nurses who had come with the emergency helicopter had been trained in capnography."

Nothing here tells me the nurse provided care to the hospital, though it is implied.

If the air ambulance transported a code, what a waste of a valuable and costly resource. I have NEVER seen this before.

The physician needs a spine. He is the code leader. After 96 minutes he is taking a poll to find out if everyone is ok with call it? Is this a joke?

For me it would have went like this for the person charting to document: Ok so what do we know, its been 96 minutes of escalating therapies without appreciable response from the patient. I am calling the code, note the time.

In summary, while this is a shining example of how not quitting does work. I would call this one in a million. Any other code would have been called.

And the nurse. She wanted to screw around with a higher deity's turf and despite all clinical signs to the contrary she wanted to see what she could do. 99 times out of a 100, the person with a 96 minute down time is a vegetable. She took a huge gamble. Yes, she was proven to be right in this instance.

Even a broken clock is right twice a day.
 
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abckidsmom

abckidsmom

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We had an ROSC survive to discharge last month. When I got there, he was 10 minutes down, purple and pulseless. I considered not working him at all, but it had been a while since my last arrest, so I went on ahead.

And then we got pulses back.

And then he was coughing on the tube.

And then I heard he came home.

I wonder how many codes I never started because the of the mentality of "he's dead...I'm not going to interfere with God." I certainly have been through my cynical, negative days.

An hour of sweating in the sun on a July afternoon and this guy gets one more Christmas with his grandkids. One more fall. Another chance to share his memories with his family.

Can't say that I'll be working any arrest for 96 minutes, but the lesson from this one was that we owe it to the people to start it more times than we actually do.
 
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usalsfyre

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I have no problem starting, but also no problem quitting. This guy is the anomaly. We can't base practice off of anomalies. Even if we sometimes miss that "one-in-a-million". Resources are too finite to waste on situations like this.
 
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silver

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You know everyone loves a great news paper article about them, even if it is "slightly" inaccurate.

why did a helicopter transfer to this hospital (supposedly a large medical center) and then say cya we're going to the Mayo Clinic?
 
Sasha

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Oh grilled cheesus, now you're going to have EMTs working rigored babies because you NEVER GIVE UP!!! EVER!
 
medic417

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Shishkabob

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usalsfyre said:
Basing practice off of one anecdotal case is poor medicine.
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Found a study not too long ago correlating that the time to call a code is when capnography falls below 10.

Although it's technically not in our guidelines, usal, that's usually when I call it (if EtCo2 was above 10 in the first place)


Capnographic measurements have been evaluated as a prognostic indicator of outcome in cardiac arrest. Ahrens et al. recommended using capnography for its prognostic value (33). In a study of 127 patients, all but 1 patient with an end-tidal CO2 value less than 10 mm Hg died before discharge (33). The results of this study were confirmed with another prospective investigation involving 139 adult victims of out-of-hospital, non-traumatic cardiac arrest. None of the patients with an average, initial, and final end-tidal CO2 level of less than 10 mm Hg were successfully resuscitated (34).
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http://www.capnography.com/Emrmedicine/capnographyinemergencymedicine.htm
 
DarkStarr

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abckidsmom said:
We had an ROSC survive to discharge last month. When I got there, he was 10 minutes down, purple and pulseless. I considered not working him at all, but it had been a while since my last arrest, so I went on ahead.
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and you considered not working him?

I work with a medic that has a mindset of wanting to call people before we even get on scene, so far, she's been lucky.. but 10 minutes? Really??
 
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shfd739

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Sasha said:
Oh grilled cheesus, now you're going to have EMTs working rigored babies because you NEVER GIVE UP!!! EVER!
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The other day a medic said if he went to an obvious baby death he would begin working it and transport. We asked why and he said he didn't want to have to tell the family their baby was dead.

Granted that isn't nice news to deliver but to begin treating and get their hopes up only to have the ER say it was beyond pointless to treat/transport is stupid.

I believe someone spoke up and told said medic to get a spine or get out.


---
- Sent from my electronic overbearing life controller
 
abckidsmom

abckidsmom

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DarkStarr said:
and you considered not working him?

I work with a medic that has a mindset of wanting to call people before we even get on scene, so far, she's been lucky.. but 10 minutes? Really??
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I'm actively working on shaking off that mindset. I admit it to be a fault. There's no defending it at all, right?

And that was 10 minutes down at dispatch, with our 8 minute response. But still. Absolutely no defense.

I think that somewhere between calling people while we're en route and working them for an hour and a half, there's a medium that's likely perfect.
 
abckidsmom

abckidsmom

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