Posted by: medicblog999 | February 8, 2009

A Successful Resus?

funeral

Michael Morse over at Rescuing Providence tells us about a job he recently had with an 11 year old child in cardiac arrest. Amazingly he and his colleagues managed to get him back and delivered him alive to their ER.
His post brought two thoughts into my head. One I will post about now and the other I will write about at a later date.

Reading through the comments to his post, it is all very positive and everyone (me included) is saying what a great job they did. Then, at the very end of the comments he informs us all that unfortunately the boy died the next day.
This almost changes the feeling from ‘what a great job’ to a ‘horrible job’. Which brings me to my point:

What makes a successful resus?

There are many different definitions of this, the most common is the ROSC (return of spontaneous circulation). This means that the patient has recovered from cardiac arrest and now the heart is beating by itself again and producing sufficient pressure to palpate a pulse. The patient may still be unconscious and not breathing but this is still classed as a ROSC.
Personally, my own definition of a successful resus is only when I hear that the patient made a full recovery and was discharged back home to their family to continue their lives. These are VERY rare but wonderful moments when you can really say that you have saved a life.
The vast majority of the time, the best I can hope for is a ROSC and a short stay for the patient in an intensive care unit before they die or have their ventilator turned off.

They will never regain consciousness.

Is this really a “successful resus”?

I would argue that it most definitely is. Agreed, we have only delayed the inevitable death of the patient, but what have we done for the family?

Instead of family witnessing their loved one drop to the floor suddenly, without warning and that being their lasting memory of their death, or getting a phone call from the hospital, or a visit from the police, they now get the chance to see their loved one for a final time.
They get the opportunity to say goodbye, they get the opportunity to say how much they love them. If they are religious, they get the chance to pray or have the last rites performed.
The success is now in the shape of what you have done for the family, and that is a gift that is beyond any statistic or performance indicator or successful resuscitation’s.

As far as Michael, his colleagues and their 11 yr old patient. Well done!!

His family will never forget what you all achieved for them!

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Responses

  1. I’ve been banging my head against a wall all day trying to articulate what you wrote. Thank you! I hope you don’t mind, I’m copying this onto my bolg. I’d do a link here but It never works when I try it.

  2. No problem Michael,
    Glad to have helped!

    Take Care,
    Mark

  3. Sorry for the cynicism, but surely a “successful” resus is one where a defibrillator and O2 were present within 8 minutes. If the patient survives, then that’s a bonus.

    Attend at 7½ minutes and the patient dies – success. Attend at 8½ minutes and the patient survives – failure.

    • I know what you mean, I think we would all like to see the end to all of this ORCON stuff, but we know that is never going to happen. I would far rather see the focus on getting the right skills (with the right numbers of staff – more on that in an upcoming post!!) to the right patient as quickly as possible, than anyone with a shockbox at any cost within 8 mins!

  4. Hey 999,
    Couldn’t agree more that my definition of a successful recus is one where we can give the family a chance to say goodbye.
    The percentage that walk out of the hospital neurologically intact is slim and of course I’d like to increase that number, but if we can get clinical life extended even long enough for local family to pay their respects – Mission Accomplished.

    the Happy Medic

  5. […] use our skills at resuscitation every day. Mediblog999 wants to know what constitutes A Successful Resus. His conclusions made me rethink my […]

  6. Unfortunately the cost involved to let a family say goodbye is for the most part shouldered by all of us, and it is at great expense. I’m not talking only financial expense.
    You are referencing an ll year old that has life support removed 24 hours later. Either there is more to the story (a pre-existing terminal condition), or the child sustained unquestionable devastating hypoxic injury. Otherwise it is unlikely providers would recommend immediate withdraw, or that the family would accept the recommendation.
    More often I think the resuscitated patient has a longer course involving cooling, many- many tests and interventions as indicated. All of this effort fuels the families hope that the person will survive because obviously the care providers believe that or they would not be doing so much to fix and sustain life. Then with enough ventilator and vascular support the brain stem adjusts so the patient sustains on his own. Time for a trach, peg and long hours of care; now the family has even longer to say goodbye. Is that successful?
    As the bulk of the baby boomers age can we offer this opportunity to say goodbye to everyone who has an arrest and wants to be resuscitated? Our health care community/country has a lot of hard decisions ahead of us.

  7. I can see why this would be a comforting thought, as it justifies those big-time interventions and makes you feel all warm and fuzzy because you made it possible for the grieving family to gather round the bed in the ICU to “process.” (Yes, I know you didn’t use that word, but that’s what you meant.)
    Think about this, though: do you want your last memory of your child to be seeing her gorked, tubed, drooling, perhaps with defib burns on her chest, unresponsive, edematous, surrounded by hubbub and people and lights and noise, with no privacy (unless you think that little room off the ICU is worth spit for this), and the pervasive smell of futility in the air?
    Sure, it’s a tragedy when somebody drops dead at home or on the soccer pitch or in the store; if prompt, as in immediate, resus is available so there is a chance of a genuinely good outcome, well and good. But what happened when your great-great-great-grandma had her big old stroke at home, or her brother got kicked in the chest by a horse, or her niece bled out in childbirth? The family mourned, had a funeral, went to the churchyard, and went on with life. They mourned, but they had a good understanding of death as a natural part of life that doesn’t have any place in modern medicine, to our detriment.

    Having seen way too many prolonged deaths, the vacant eyes of the family as they come in and out of the ICU, I know this: There was no chance to say goodbye here. That train left the station at minute 7 1/2. Two days later has far too many opportunities to make awful memories that will never die. Let them see their child or their grandma in the quiet room off the ER, clean, looking as if she were sleeping. She is. Give them the mercy of a better last memory.

  8. Dee and G`anny,
    Thanks very much for your comments on this. It is always interesting to hear another perspective on my thoughts and I can see, most definately,both sides of the argument.


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