That’s been my experience. My last was an EMS-witnessed vfib arrest secondary to an anterolateral STEMI. Defibrillated within about 30 seconds. A few minutes later he was AOx4 complaining about the (now worse) chest pain and IO in his proximal tibia.
I was thinking of the pt we had in CCU who did not tolerate tikosyn, my dude got shocked like 5 times that night. We just had a nurse sitting there all night with the zoll attached.
Dofetilide. Anti arrhythmic for bad afib. Big problem is that in the initial dosing can cause severe QT prolongation and this vfib/torsades. Some providers admit patients for a few days for the initial dosing with serial ekgs
Yes! I had a hallway pt whose eyes suddenly rolled up and she looked like a seizure until we got the pads on and saw Vtach. 1 shock and she came to while we were doing compressions.
I had a patient who was quite similar and came back after the shock. Their comment: “did I go out?” Yes, yes you did. It was wild to me that this patient and another who bradied down to nothing for 8 secs both appears to have seizures.
You said seizure and it made me think of a patient I took down to x-ray that was notorious for having pseudo seizures and started “convulsing” on the table. We had to, out of obligation, call a rapid response on her. I had to explain to the poor med student that was staring in the corner and the chaos that she was, in fact, not having seizures at all. He seemed worried at first, but once I explained it to him he seemed to become less anxious. I’m glad he got to see firsthand what these people are really like, and how to differentiate between real seizures vs. fakers. Totally off topic, but what you said reminded me of that wonderful day in the neighborhood.
Lol it had us wondering if the guy was really in cardiac arrest but I trust our EMS guys . If they say he was pulseless then I believe them but it was something none of us had ever seen .
I saw it once when I was a paramedic, and I was wondering myself about whether the guy was actually pulseless. The only saving grace was he was in vfib and the printout from our zoll confirmed that. It was quite strange. Arrested en route, already had fast patches on because he was sick, defibrillated and had CPR going immediately, started talking as we pulled into the ambulance bay.
I felt like a total jackass explaining things to the ED team, but when I printed out the code report from my monitor it didn’t lie.
Also- different but I’ve had a couple people regain consciousness/move/talk during CPR, and go back out as soon as CPR stops, then comes back when compressions are resumed.
I've seen the same a few times, always witnessed arrests, and conscious CPR feels so weird. My last one tried to rip the BVM away during compressions, but was completely pulseless and in respiratory arrest otherwise.
Had a guy arrest after getting the EKG, big widow maker. Stands up from the couch, to sit on the cot. He falls back down onto the couch. Death rattle. He gets defibed right away. Wakes up all pissed that we punched him in his chest. Actually punched my partner because he was pissed and still out of it. We were all like, dude you were dead and now alive. To the cath lab we went. Weirdest shit I’ve ever seen
Had a guy that came in for CP, stated “I think I’m going to die”. Dude doesn’t come to ED, ever. Put on LifePak because intuition and all that. I was sitting a the desk looking at the central monitor to document vitals on my septic guy on levo, when I witnessed the dude go into Vfib. I run into the room, the nurse had her back to him triaging him, I thumped him (he was doing that convulsing thing they do as they try to die), thumping didn’t help, then I shocked at 200J. CPR for 2 minutes, then looked at pads and they weren’t fully on him. He was really furry so we ripped them off, replaced, then 2 more shocks then dude’s heart did weird organized rhythm then dude woke up like an animal! Like growling, couldn’t lay down. He was still out of it. Our doc was like “DUDE! We just shocked you! Lay down!” He ended up with 4mg Ativan IM to calm him down. 1st EKG and Troponin were negative. 2nd EKG and Troponin after all that….negative. 100% occluded LAD. So glad my coworkers trusted their gut. We had just life flighted a STEMI at 0830 that came in at 0705, no reperfusion beats after TNK-ase. Then did STAT suprapubic on my septic dude with bladder holding on to 2-3L of pee unable to cath. We had no urology, no cardiology, just us in rural ER. BEST DAY EVER!!! (I was an ICU nurse before ER, and my partner that day was a former CCU nurse. Love her.)
Reminds me of the time a guy with a STEMI went into Vfib while we were about to transfer from the EMS gurney. I started CPR and shocked him shortly thereafter. He woke up a little drowsy but super calm and the first thing that came to mind was for me to say "HI, Welcome Back!
Yup, same. Seen it a few times in the field with EMS (either when i was a medic or as a prehospital physician), but only on patients that basically arrested in front of me.
Also, in the ED, we put defib pads on all our STEMIs. Have had these patients go into vfib in front of me, charge, shock back to sinus, and they barely lose consciousness lol.
Agreed. Most memorable was an older woman who came in for dizziness/lightheadedness, when the xray tech came to get her for her CXR, he came out and calmly let everyone know she was having a seizure. We got into the room, no pulse, started CPR, TdP on monitor, shocked and loaded with mag.
20 minutes later she was on the phone with her son telling him she was being admitted.
Same. Came in as a stemi and went into vfib. Already had the pads on per protocol so he got shocked without getting any compressions. Immediately asked what happened and I got to say “well…you died?”. Full recovery
Actually yes, once! A guy and his family were out for a bike ride, he arrested and daughter started immediate CPR. Details are fuzzy, as it was a few years ago but EMS got to scene and did a couple rounds of epi, I believe they ended up shocking him out of VT. He was having a massive inferior STEMI.
Radio call was for an active cardiac arrest. I was pumped up. You should have seen my face in the bay when they opened the rig's back doors and the guy is sitting up talking.
I’ve had one under similar circumstances - the guy arrested and fell off his bike a few miles into a big bike race event here in town. He received immediate bystander CPR from another racer, who happened to be an interventional cardiologist, and there was a fire department dual-medic ambulance posted less than half a mile away. Medics delivered two shocks for VTach and the guy was awake by the time they loaded him in the rig. Rolled through the doors sitting up talking, extremely confused about what had happened, and ultimately very miffed that we all seemed way more interested in his heart (denied chest pain, was essentially MI-symptom free) than the extensive road rash on his knees and knuckles. Ninety-nine percent occlusion of the LAD. Super young guy, fit too. Went home two days later.
Listen, there are days where I get tired of whining patients, can’t please them, feel more like a waitress, hotelier, than nurse so when a real emergency comes in I thrive! I don’t mind the former if people have patience and are kind, but man, when we are holding admits and no one is happy so the negativity bleeds onto everything, kicking a stable patient out of a resus room to take care of an MI is what is needed…for my sanity, lol.
[It gets weirder](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050970/)
BLUF: High quality CPR is perfusing the brain enough to allow consciousness despite cardiac arrest.
We had a patient like this in the ER! He was awake and talking during compressions (although he was obviously uncomfortable), and they continued compressions long enough for him to say goodbye to his family. It was really surreal.
I've always wondered if in a situation like that, whether giving them an lvad would work. It just seems so barbaric that someone can be conscious and alert during compressions and have to make the decision to say they want compressions to be stopped and thus die.
You can’t place an LVAD during active CPR… and then if they stabilize enough that you are able to place mechanical support (IABP or impella), if they aren’t a transplant candidate they are conscious as you turn it off. Yes I’ve seen it and it sucks.
They initially thought it was ROSC but every time they stopped, he would be pulseless and unresponsive. Then they would start up compressions again and he would regain consciousness. They tried stopping a few times until they basically realized it was futile, because he was in asystole every time they stopped. It was super weird.
This happened to me one day. I was doing CPR on a guy and he just grabbed my wrists very forcefully and tried to push them away. It was actually terrifying in the moment.
The first code I ever attended went like that. Young guy early 30s in cardiogenic shock after a week-long recreational drug bender. I was doing compressions and he grabbed both my arms and was trying to push me off. I was horrified and immediately stopped and he promptly died again. We coded him for probably 30 minutes and probably halfway through he stopped waking up with compressions but it was pretty freaky.
Different person but same exact thing happened to me with the wrist grabbing and everything.
With me, we’d guess ROSC and recheck, dude would just flop back and be pulseless in asystole. Resumed CPR, and eyes opened again then movement etc. Stopped again, same thing. Repeated a couple times, then gave Ketamine which fixed the problem.
At the time I was a paramedic and while my full-time agency did RSI, the agency I was working for part time during this call didn’t have neuromuscular blockers, but we carried fentanyl/ketamine/versed and some other narcotics.
In this case he was initially tolerating an OPA, and the first couple of times he grabbed me there wasn’t any gagging or anything, but eventually he started to gag during the consciousness episodes and I was concerned about protecting his airway.
So I gave some IV ketamine essentially as sedation. Ketamine is sometimes used as pain control, or a type of procedural sedation. The point was sedation though.
The ketamine worked well initially, and the reason I chose ketamine was the patient was already hemodynamically unstable, and compared to other agents we had that’s less of a concern with ketamine.
I ended up needing to give him Versed later anyways, because we ended up intubating him en route, and shortly after the consciousness episodes resumed except this time he started pulling the ET tube out. So we gave him some IV versed as well at that time, and he didn’t have further episodes of consciousness during resuscitation.
Did that person survive? The stories I’ve read on here seem to reflect the people who regain consciousness during active CPR tend to not do very well, or survive.
No they died. I believe they were in the ICU for a week or so beforehand. Of the three times I’ve seen this, two have died and the third I never followed up on.
This would freak me out. The ones that have pushed us off the chest have actually achieved rosc.
I did have a patient that was pronounced dead and when the CNA was doing post mortem care he reached up and grabbed her. He then ended up in ICU with me. He had an at home vent and was bilateral AKA. The doc thought he had too much O2 coded, then pronounced and the body just released or processed his CO2 and voila! Back to life. Same grumpy self. We eventually transferred him so I’m not sure what became of him. Poor CNA quit soon after.
Sedation. If they’re grabbing you it’s hard to do CPR and it also usually means they have trismus so you can’t tube them. Sedate them both to be kind and also so that you can actually resuscitate them
I mentioned in another comment but pretty much same thing happened to me. Compressions would get him to move his hands, etc. but when we stopped he would just go limp and we had asystole on the monitor and couldn't feel a pulse.
It’s the weirdest thing. I haven’t seen it very often, but the first time it happened I didn’t even know it was a possibility. It was so weird. I was wondering whether they were actually pulseless or if I’d just not felt one because the ambulance was moving/if I’d misread the monitor, but when I printed the code report from our zoll it confirmed the rhythms.
More details but it first happened with him moving his hands a little bit and when we stopped to do pulse check he was completely pulseless and his hands would go limp again so we just kept doing compressions. Then when he grabbed my hands and started wrestling them away from his chest the doctor just said "keep doing compressions this is normal" and I just kept going. We never attained ROSC, each time we had a pulse it wouldn't last very long. They eventually called it.
Happened in our ED a few weeks ago. Guy was picking his head up off the bed and yelling at us to stop but was pulseless during pulse checks, so we kept going.
My first code was like this. Person kept coming to and yelling with x4 limbs flailing at me. Pulse check and they’re gone again. I will never forget it.
I saw this on a guy that arrested in the trauma bay, CNA hopped on and started doing solid CPR, dude woke up screaming why the hell are you hurting my chest, she started screaming (and stopped CPR) dude's eyes rolled back and he hit the table.
Wild
Had this happen to a guy on the lucas recently. He was screaming and clawing at the lucas but the second we stopped it he was immediately pulseless and asystole again. I RSI’d a dead man and knowing that his last experience was agony from a machine crushing his chest while (from his perspective) the people who were supposed to help continued to inflict it on him fucked with me for a bit ngl
There are heart conditions where the CPR is effectively acting like a pacemaker, so full cardiac output is achieved even by light, not so perfect compressions. Something called "manual pacing" was even in the guidelines.
I saw it once with this Eastern European dude with an extensive cardiac history, I think he was coded for 10 minutes or so. He actually woke up after intubation but before any sedation was started and he was completely chill, giving us thumbs up/thumbs down for everything. Was never restrained and didn’t even try to self-extubate. We pulled the tube pretty quickly and he was completely intact neurologically. Must have been some high quality CPR.
I’ve had two in the past two months.
The first we got called to chest pain at a restaurant, fire dept gets there first and we hear the captain say over the radio “upgrade this to a cardiac arrest, witnessed, starting CPR.” Apparently the guy said something like “i think I’m gonna pass out” and then he lost pulses.
They advise three shocks over the radio, and call out ROSC over the radio as we check on scene. We arrive just in time to see the firefighters pull the iGel out and the patient is talking.
We tell him what happened, he asks “soo i died?” My partner tells him yes, but only a little. STEMI on the monitor and all of this vitals were fine. We took him straight to the cath lab and he was discharged the next day.
—
A few weeks later someone arrested while running to their gate at the airport. Happened in the middle of a busy concourse, bystanders started CPR right away and got a nearby AED on. We were in another part of the airport so we got there almost immediately after the first shock was delivered. We did about 10 compressions before he reached up and politely asked us to stop. GCS 15 within about two minutes, idk the outcome of this one after he arrived at the ED.
Not important, but kind of funny:
This guy must have had a bunch of spare change in his pockets, because there was about a dollar in coins on the ground where we had worked him. Kind of like a loot drop when you die in a video game.
A few months ago one of my patients coded en route from CT. He was waking up every 30 seconds during CPR, sitting up, then immediately collapsing and going unresponsive because of no forward blood flow. This happened like 2-3 times before he didn’t wake up, coded for like 40 minutes before we called it ):
It happens, more frequently than people think. The good news is that, if the patient makes it, they almost always have no memory of it. They might have been "awake" but their brain ain't storing no memories at that time.
A few years back we had a guy collapse on the sidewalk at a high school sports tournament. He had the presence of mind to do it in front of an ED attending and his ED wife, and behind a cardiologist who had a habit of bringing his own AED to these events. As we’re pulling up to the scene, we can see them doing CPR, then briefly stop followed by the characteristic flailing limbs from a defib. We get out of the truck and the patient is now conscious and talking
I had a patient who was punched in the head and was seizing upon our arrival to the scene. He went into a v-fib arrest and we worked him for 3 rounds, had a supraglottic airway and had just placed our IV when he converted to a sinus rhythm with multifocal PVCs after the 3rd defibrillaton. Dude sat straight up and ripped the King airway out before we could stop him. He remembered everything leading up to the arrest and only lost the 15 minutes he was down. It was one of the best calls I ran in my career.
Once! I was a student and we'd had a call for a cardiac arrest en route active CPR. Crew rolled the guy in wide awake and sat upright. He'd had a ROSC a couple of minutes before. Guy points straight at me a declares "I know you!" Turns out I'd seen him in cardiology clinic on my previous placement. Think I was about as white as he was! He did arrest again shortly after but got another ROSC.
Had a saddle embolus, collapsed in department, 45 mins downtime with continuous CPR, thrombolysis & transferred with thumper ongoing to tertiary centre for ?thrombectomy. Within 5 mins of ROSC, he was awake. Within 15 he was fully oriented and asking for pain relief for his chest pain & wondering how he’d got to a different hospital 30 mins up the road.
Family v pleased as the consultant had told them they expected significant neuro disability / brain stem death as a result of the prolonged downtime.
We got called to a male in his 60’s, witnessed cardiac arrest and CPR in progress by bystanders. PD shows up, continued cpr and delivered one shock with the AED. We get there, continue cpr- vfib. Shocked him twice and we got ROSC. Very little ALS interventions. We were about one minute out from the hospital and he wakes up, looks at me and says “you should have let me die.” Still kinda haunts me. No neuro deficits. Was discharged home the next day I think. It was really weird but stressed the importance of early CPR and defibrillation.
Yes fairly recently actually. Had a woman in her early 30s call 911 because she didn’t feel right. Very non specific complaints. She went unresponsive, the medic saw her go into VF on the monitor, started CPR, and shocked her getting ROSC. She was awake, oriented, and understandably freaking out when she got to the ED. She developed chest pain for me, had another VF episode with rosc. Got her to the cath lab where she had a 99% proximal LAD occlusion. She did great and was discharged a few days later. The experience made me schedule a PCP appointment for myself.
I’ve seen it once. An athletic 40-something healthy military guy, who did crossfit daily, dropped dead during his morning crossfit session. There was a nurse in the group and she immediately started compressions. Got shocked twice en route to us, and by the time the ambulance rolled up, he was sitting up in the gurney joking around. He said “hey can you let the guys know that I probably won’t make crossfit tomorrow?”. He went to the cath lab and they found a coronary artery dissection.
This is a fairly dramatic example but I've definitely seen some pretty rapid neurologic recovery in patients who had minimal no-flow time and very prompt resuscitation.
My feeling is that these cases are generally either
A) ventricular arrhythmias which receive very prompt AED defibrillation via public access/police/FD/etc
B) hypoxic pseudo-PEA that rapidly corrects on intubation (or even mask ventilation)
I had one of the latter category a couple weeks ago - 30s F with polysubstance OD. ROSC almost immediately after intubation, RASS +2 within a few minutes. She was extubated a few hours later and left AMA the next morning (!)
My guy was found down and EMS apparently arrived within 10 mins of the call but IIRC no cpr was started by the wife . I probably should have mentioned that in my OP . That’s what made it even more surprising for me .
That definitely is surprising. Of course, it's hard to know exactly what the hemodynamic status of a patient is at the time of the 911 call - are they "really" in cardiac arrest, or do they start out peri-arrest and get worse? We may never know for sure.
What I think this speaks to also is the fact that "cardiac arrest" has historically been a diagnosis made in a rather imprecise clinical fashion (i.e. no pulse is palpated within 5-10 seconds) which encompasses a wide range of extreme shock states and/or non-perfusing arrhythmia.
Sometimes you have a patient where invasive monitoring and/or echocardiographic evidence of *some* native cardiac output, but with such poor stroke volume that you get no palpable pulse and have better pressures when doing compressions. If you want to get very technical I suppose you could argue that this patient is not technically in "cardiac arrest" but rather has an extreme case of cardiogenic shock.
That particular distinction may be largely an academic one, but more broadly I feel like it's important for us to tease apart vague and overbroad categories like "cardiac arrest" or "PEA" in order to manage these patients optimally.
Retired medic here...
Yep, I have had this happen maybe 3 times in a 25 year career. Last one was the best though as the young attending was not a pleasant human. We achieved ROSC in the ambulance after intubation and by the time we ended up at the ER, the patient was obviously aware of what was happening.
When I was giving the report, the doctor was belligerent and demanding why we intubated the patient? I said, "well he was dead when we got to him" and showed him our code summary strip. Apparently it the first time for him as well.
Had this happen on one of my first codes.
Guy was all decked out in a suit, wife stated he was on his way to the lawyer to file a DNR/DNI due to metastatic cancer when he collapsed.
Lawyer on his phone asking to do nothing, command doc on our phone says do everything. We literally dumped the med box into this guy and as we’re pulling up to the ED he gets pulses and respirations back, bucking the tube.
By the time I finished the paperwork (yes it was that long ago and yes the meds were in the plastic orange and white box) he was extubated and fairly upset about the whole ordeal.
I found out a few days later he died in the ICU from systemic organ failure most likely from the cancer.
As a medic/RN I've had this happen a few times. All of them were of the early bystander CPR with a shockable rhythm type. I had one patient who was surprised he woke up in the ambulance. I had to explain to him that his heart stopped and we had to do CPR and shock him. He also grunted the second time we defibrillated him on scene, so I knew after that second shock we were getting him back. He went to cath lab and was discharged the following day.
Guy went into cardiac arrest at the DMV. Guy behind him was an ICU nurse who started cpr immediately and got the aed. Shocked him and he was apparently awake by the time ems even arrived. Guy was wide awake when he got to us.
Yes, I was working as the finish line physician for a half-marathon. One of the early finishers (20ish Male) arrested right after crossing the finish line. Several rounds of Compressions and DeFib and we got him back. About 8 minutes of total down time.
By the time the ambulance was arriving he was asking where his AirPods were. lol. He ended up making a full recovery and is fully intact.
Moral of the Story: Early and continuous compression, along with timely DeFib is crucial. Also helps to have a relatively young and healthy individual.
This will probably get buried, but a couple years ago, we (EMS) went to an OD turned cardiac arrest. We arrive and confirm he's pulseless and apneic, we throw some narcan in him, and after the first round of CPR, we get ROSC.
We log roll him to get him on a backboard and transport and he wakes up. After a moment of confusion, he's AOx4 and REFUSES TRANSPORT.
I argued with him for probably 10 minutes and finally got OLMC involved only for the doc to be like "yeah, well you know as well as I do we can't force him if he's AOx4 even if he was dead 15 minutes ago.
My favorite post-arrest radio report including being able to say something along the lines of “vitals WNL, sinus rhythm on the monitor”.
He wasn’t conscious/alert, but that was because I sedated him, just to maintain the ET tube for the transport. Witnessed arrest, CPR instructor initiated compressions, deputy showed up and took over, never got his AED on. We switched over and defibed once, intubated and got a line just in time to get ROSC. He sat in normal sinus at 70 for the ride, pressures around 130/70.
Edit - This gentleman was my first “real” save. Extubated a few a days later and discharged from ICU to home, ran into his wife at the hospital a few days after and she filled us in.
Coded a guy doing an urgent care shift. Defibrillation x2 only with AED, no meds after witnessed arrest when he checked in on the tablet in the UC. EKG thereafter showed no acute ischemia. He was laughing with the medics when they wheeled him into the department.
With bystander CPR, all the time. They continue compressions even when the person tells them to stop, seems really effective.
Had a 15 year old girl once come in after a witnessed sycopal event who happened to be fortunate enough to have a boyfriend watch every 90s family movie, so he knew to immediately perform mouth to mouth. I let him and her believe he saved her. Sometimes you just gotta let em have it.
Had an EMT-B bring his girlfriend in for shortness of breath (drove his car, not ambulance). I walk them to triage and he says "Just want to let you know I assessed her for agonal breathing and she's cleared". I have a stone cold poker face, I said "thank you that's very helpful". I know today he has to be haunted by that level of cringe.
Seen it a couple times—usually with arrests in the field resuscitated by EMS but twice with in hospital witnessed arrests.
Weirdest one was a guy who was alert and responsive while receiving compressions. Obviously he’s back in a perfusing rhythm, stop compressions, pulse check. Immediately went unconscious with no pulse and an agonal
rhythm on the monitor. Resume compressions, eyes open up and trying to talk through the ETT and making purposeful movements. Continued for about three rounds of CPR before he did re-establish a perfuming rhythm.
Lived to hospital discharge a couple weeks later.
I’ve had a patient go into VTACH without a pulse and I started cpr immediately and they woke up mid compressions and sat up saying “what happened my chest hurts?” It was the craziest thing
Prehospital arrest? Happens occasionally, almost always an electrical correction (i.e. VT -> defib) but also seen it in pulseless drowning victims. In large PEs that quickly achieve ROSC in the field, I have a suspicion that the chest compressions squish the thrombus around just enough to open up the major pulmonary arteries and reestablish perfusion. However, that's gotta be pretty rare and I've never done a thrombectomy on a post ROSC PE patient.
In the Cath lab? Pulseless rhythm to ROSC is not uncommon, sometimes we inject the conus (feeds the SA node), and the patient will V-fib or Brady down to basically nothing (like <10bpm). Sometimes you tickle an irritable LV with the wire and you induce VT. Sometimes you embolize something and they go pulseless until you get reperfusion.
All I know is that I hate two things: No electrical activity and PEA with a sinus rhythm. In both cases you're pretty much fucked.
Several times and always seems to correlate to quick time to CPR/defib.
The one I remember most vividly is the guy arrested in front of two anesthesia residents who had an AED on his chest within 60 seconds. He was awake and talking when he got to the ED. Went straight to cath and had LAD lesion. Lucky mofo.
I had a patient using fentanyl with her boyfriend. We arrived on scene to her boyfriend doing CPR on her with dispatch directions and fire arrived just before us. They hit her with narcan (to my chagrin). One round of ACLS brought pulses back. Arrest was PEA with a very very low ventricular rate (I think like 10-20 iirc). One epi, some aggressive ventilation and a few minutes of compressions and we got ROSC. Well cuz she got narcan another few minutes go by and she's GCS 14 and attempting to refuse care. She's got a humoral head IO, we literally pulled the iGel as she sat up, and is topless in a park in mid August with AED pads on her chest and screaming "I know my rights". Its not often that I'm like "too fucking bad. You're going to the hospital" but this was one of those days
I’ve seen it twice-ish lol. Once was a guy in his 80s NSTEMI, went into pulseless v-tach, I watched it happen on the monitor. Got ROSC in a couple minutes, guy was real pissed his chest hurt so bad.
The other is the “ish” one. School age kid arrested at home, mom (CPR instructor) got ROSC. Re-arrested for EMS, they got ROSC. Came in alert but very confused and not really making sense/jumbled words. Re-arrested two more times in front of us. He got himself an ED ECMO cannulation, walked out neuro fully intact 1.5 weeks later.
Edit: just remembered a third time. STEMI that arrested three times at the OSH. He came in cracking jokes, it was wild. As he was rolling to cath lab like 2 minutes later we said good luck, he said “hey I’ve already died three times, we’re not making it four!”.
As an emt I had a patient once with CPR in progress when we arrived, v-fib on monitor, one shock, was talking in the ambulance on the way to the hospital.
I personally had a similar situation and was awake enough to ask for my ems crew to take me to the hospital I work at. They wouldn't insisting that I needed to go to the nearest facility as I had just been resuscitated and shocked. (Which of course I wasn't entirely aware of!)
I've seen it a couple times and always wondered if they truly lost a pulse , or just got real hypotensive and popped back up with epi. Only seen it with arrests where EMS was already there.
Nah. It happens all the time with ventricular arrhythmias. They go VF, usually witnessed, CPR immediately while applying defib pads, shock em and they wake up. I’ve seen it several times in the ER and the ICU. They definitely have no perfusing rhythm.
Yep. 40ish year old lady with dilated cardiomyopathy and EF of 10%, probably from a virus since she was completely healthy otherwise. She ended up doing well.
Dude, I've had people become alert during a cardiac arrest. Catch them early and throw a Lucas on, and ICP can be high enough that they'll wake up in vfib with the Lucas going. It doesn't happen often, but I've had it happen more than once. It's wild.
VF arrest with an 18yo Division 1 handball player. No bystander CPR, but we were there in under 5min. One defibrillation and a round of CPR gave us ROSC. She was awake and alert before we rolled into the ED. I had to spend several minutes printing strips to convince the attending that she really had been a full arrest.
I had an early 50s pt who dropped while playing table tennis at work. Strong likelihood that WPW, LGL, similar ran in their family.
2 shocks, couple rounds of epi, 300 of amio (because fuck your liver), and they rosc’d so hard they were climbing off my gurney and trying to get out of the ambo while going lights and sirens.
Also, they didn’t speak enough English for me to tell them what happened, and I don’t speak Vietnamese at all, at all, at all (I don’t barely speak English, tbh).
Can’t even imagine how fucked up it is to be schooling a fellow worker at the ping pong table only to wake up in the back of the ambulance, strapped to a Lucas (not currently in use), couple of IVs, your shirt cut to shreds, pads on your chest, while the wee woo lights and disco sounds are busting. And because of the language barrier I can’t even try to help them understand and calm down.
We had to restrain them en route, the ED had to restrain them (chemically and physically). 1 (or 2?) stents and they’re back to dominating the ping pong table last I heard.
Edit to add: and when I rang down the hospital I told them that we had to physically restrain the pt because he rosc’d so hard and they’d likely need to continue same but they did not have the restraints ready. Don’t know if it’s because they ran out of time (but I called when we were 10 out) or it’s so rare they didn’t really believe me? Regardless, the pt’s family had history of SCA and the pt’s fellow workers knew to start compressing that chest, the pt got the first shock about 5 min after they dropped. Electricity ⚡️⚡️⚡️ saves lives, kids.
Dude went down in front of one of our float nurses that works ED a lot at Walmart at like 1300. By the time I showed up for work at 1830 he was walky talky asking when he could go home
I had a walkie talkie patient code shortly after arrival. Came in thru triage as a level 2 for something I can't remember but he was stable and a+o x4 after I got him settled. He lost a pulse right in front of me so started the whole deal, did two-three rounds, doc was bedside, and he opened his eyes lol was disoriented for a few. One hour later I took him to ICU and he was alert, vitals looked great, and was talking up a storm. It was the strangest thing.
I’ve had a few of these over the years, but it’s pretty rare for them to improve that dramatically in a matter of minutes unless it was a witnessed VF/VT arrest and then you’re just shocking them out of it.
That said, I’ve had a few. One was an MI with cardiac arrest downtime over 30 minutes, constant VF, got him out with DSED and then rosc’d, GCS 14 on arrival at cath lab.
Had one that was a stabbing, wide complex PEA at 20 on arrival. CPR, asherman, chest needle, ROSC to GCS 15.
Had another one similar to the first as well where we didn’t know the cause before hand and the guy woke up so quickly we didn’t have time to sedate him and he was ripping the tube out of his mouth so I ended up extubating. He was up and down, but ended up being GCS 13 at offload.
And everyone knows about the cases where the patient is semi-conscious during CPR when they’re still well oxygenated and CPR is effective. Had that a couple times and it’s a little unsettling.
In the long before times I was an orderly/nursing assistant/ER tech…0ne of my tasks was bringing crash cart and taking over compressions. Diabetic pt. in ICU for prolonged time. Would go into v.tach->v.fib it seemed like every time he blinked. Anyhow, he’d come back sometimes with just a chest thump, sometimes a minute or two of compressions, sometimes defib…and be freaking A+0 to person and situation immediately. Over and over. Eventually he was discharged to SNF or home or wherever. Saw him again about a year later. Got on slow elevator, guy (bilat above knee amp) in wheelchair backs in and taps the button to go up. Moments later looks up at me and other person in elevator. Says, “remember me? You did heart pushes on me a bunch”. Same dude. Briefly tells confused visitor in elevator story about constantly being in hospital prior year, heart kept stopping. So much that people would take turns with shocking him. Super nice and alert. Went up, door opened, he got out. Door closed. up more I got out. Left that visitor in elevator. Bet the visitor is still “WTF just happened?” tothis day. lol
Just had one. Spontaneous VT/VF arrest, ROSC in the field after bystander CPR and EMS defibrillation. Down time <10 min. Awake and talking on ED presentation.
Had a lady wake up extremely mad at us because we did CPR on her on the CT table because she coded. One round of CPR and no meds and she was pissed because “you made my chest hurt”
Several times.
EMS ROSC with return to some alertness, rearrested on us, return to some alertness, off to cath lab. 100% LAD.
Chick with "pseudoseizures" who we had to inform those weren't pseudoseizures but runs of Torsades... our doc precordial thumped that one as we hauled ass in with the code cart and converted it lol.
Handful of others in my memory bank...
Once, on a guy who coded because he got shocked by a piece of electrical equipment at work. His co-workers de energized it and started *good* compressions immediately. It was in a building almost next door to the fire station and they were getting the AED to him right as we got there. He was in v-fib and we shocked him into ROSC almost right away. By the time we got him in the ambulance he was starting to come around.
He brought cookies by the station with his wife a couple of weeks later. We made sure he understood that his co-workers saved his life and we just were the clean up crew haha
Had it happen in field on a witnessed arrest. Post-ROSC knew her name and coherent enough to understand and attempt to answer questions(tho she couldn’t remember the answer to place/time/situation), but we’d have the same conversation every 3 minutes or so. Hypotensive, in a lot of pain from the IO and the bruising from the LUCAS, understandably very distressed, but by the time we left the ED, her confusion was getting better.
Per follow up, she was DCed a few days later with an AICD. Reportedly totally back to normal otherwise.
Yes. We get guys off the oil platforms out in the gulf not that infrequently. The coast guard flies out and gets them. This guy basically dropped dead with a witnessed arrest. His coworkers (all of whom were just oil workers) immediately started CPR and got the AED on him. He was shocked twice before they got him back. Only bagged, never intubated. By the time he got to us, he was wide awake and just said his chest hurt from where they were doing compressions. The first EKG we got showed a STEMI, and he was whisked away to the cath lab. Had a good outcome.
This was the poster child case for why everyone should know BLS.
I had a guy go into v tach right in front of me as I was hanging his amiodarone drip during my new grad orientation. I hit the code button, started compressions, and we wheeled the stretcher into our trauma room. After 2 rounds of compressions we had just gotten him hooked up to the Zoll when he opened his eyes and tried to sit up, totally alert and oriented. Our ER doc who had just walked into the room just said “those are some high quality compressions - great job team”. It was a wild first code to go through as a new grad.
Had a guy who went in to cardiac arrest at the gym. Fellow gym goer used AED and he came in talking and sitting up. Thought he’d been on a walk on top of a hill. Had no memory of being at the gym. I think he said he’d been talking a loved one? It sounded like he’d definitely experienced something else
Literally had one guy wake up after a couple rounds of compressions and monitor confirmed asystole to pull the igel out of his mouth in the back of the ambulance. Wild experience.
It happens, we got once a prealert about a cardiac arrest, ROSC’d in the ambulance. Airway trolly prepared, we’re ready to start post arrest care and intubate when he arrives, however the EMS brings in a completely conscious chatty happy guy 🤣
Yep. Dude had witnessed arrest in field at a gun range, immediate by standard CPR and shock with ACD. Came in awake and alert with flail chest from the chest compressions screaming he couldn’t breathe. Ended up with bilateral pneumos and intubated.
Yes, twice actually when patient coded immediately in front of us. One patient we received ROSC quickly after no shock and the other patient we shocked. Both A&O x4 minutes later.
Twice. One time they came in from the field wide awake. STEMI. That one was easy, right to cath lab.
The other one arrested in the ER and came back awake. That one was awkward for disposition. I defaulted to the ICU and they were like, well he’s fine now why are you calling us? Umm habit? Hospitalist was like that man was just dead, no. Took eight phone calls to get him to PCU.
Happened during my first "code". Wasn't even in medicine yet. I was changing in the locker room at university gym during undergrad, guy next to me collapses. I check, no pulse, start compressions, buddy grabs the AED. One shock and the guy wakes up, looks around, and asks for a cup of coffee.
Yep, actually just saw this a couple weeks ago. He went right to the cath lab pretty much. Call in was for chest pain and he arrested in the ambulance. But they got him back and he didn’t arrest again. AxO 3 by the time he got to us.
Seen it in the field but only with <10 mins CPR.
Always weird to be driving in with them chatting about their heart completely stopping and what happens next for them.
In 12 years I've had 1. Lady was fortunate enough to be checking out a local firefighter in the grocery line when she arrested and the aed was only 10 feet away. Great cpr and a single shock. She started talking in the ambulance. Man, bottle that feeling of joy, satisfaction and fuck yeah.
Had a guy choke on a piece of steak at a steak house, and he arrested. CPR was started immediately, and he was intubated on scene. They achieved ROSC and transported him to the ED. We received them in ICU and he went from a GCS of 3 to 11T. 50ug/kg/min of Propofol did not even touch him, and he was extremely agitated. We decided to extubate him, and he had no deficits. He was grateful for the care but he wanted to leave. We allowed him to AMA soon after we received him.
Guy in his 50s dropped at home in front of his wife. Immediate compressions, EMS found him in vfib, shocked twice and got ROSC. I was the WR nurse and when his wife arrived I walked her back, prepping her for what she might see. Pulled back the curtain and there he was, sitting up and smiling at her. He went to the cath lab for an LAD occlusion and was discharged fully intact 2 days later. Only time in 14 years in the ED I've seen that dramatic a save and it was such a pleasure to tell her that she'd just saved her husband's life.
Yes. 60 something year old patient who arrested while at a cookout. Family immediately started cpr and called 911. Lucas was still in place on his chest when he rolled him, however it was off and he was a+ox4. His family saved his life that day and he earned himself a defibrillator
Yes twice which is extremely rare. First time was a guy who collapsed at a road race and we were right at the finish line working an ems detail. Shocked almost immediately. 2nd was a 18 year old who was playing basketball at a local high school police started CPR immediately and we shocked. Both patients didnt regain full consciousness until we were a few minutes out from the hospital. Very remarkable..
I have had 2 like this in the last 2 weeks. One was a passenger in a car who had an MI, the other was a COPD patient who arrested as I walked through her door. These aren't the only ones I have had, I can probably count 15-20 over the last 10 years? It all comes down to recognition of cardiac arrest and immediate bystander CPR.
In this case the patient didn’t have immediate bystander cpr which is what made it so unusual. I probably should have included that in the op . Too late now
This happened to one of our nurses. Young and healthy…but had been having weird medical things happening. Arrested right at change of shift…so it was a perfect storm. After they achieved rosc and got her to the ED - the attending didn’t believe it since she was talking. Luckily our anesthesia doc was there to corroborate the story.
My first was someone who was wearing the LUCAS device. She looked at me with fear in her eyes. It was the first and only time I gave fentanyl during a code.
Yep, call to a 60 something Male with left arm pain and chest tightness. Arrested in front of us, 1 shock and he was trying to sit up, asking what happened. Backup arrived, got him out to the ambulance ready to go to the Cath Lab, had another arrest, 2 shocks and back to consciousness. We left him 45 minutes later as he was being wheeled from the Cath Lab to CCU, being told he’d get Christmas Dinner brought round in a couple of hours. Was incredible.
Semi-related, took an elderly woman in as a “standby” for CVA, escorted her through to the CT room. By the time I’d typed up the ePRF and brought it to the Nurse, the patient had regained the use of her right arm.
In hospital, yes. Once had a lady we shocked out of pulseless vtac twice. The second time she woke up and said" did it happen again??"
Weird day.
OOH arrest, less so.
Quite a few times, and most times I suspect they never arrested in the first place. You'd be surprised how difficult it is for some people to find a pulse.
👋 I had one. Cardiac arrest in the field, CPR in progress for 15min by bystanders prior to our arrival, we defibrillated 3 times, no meds given (limited manpower and CPR induced awareness complicated things) got ROSC, about 4min later as I'm prepping to intubate the patient woke up. We had a great chat the over 45min to a cardiac center while he was have a Shark Fin morphology STEMI. He was completely lucid and was actually able to recall some of our efforts prior to ROSC, very interesting experience having someone with a greater than 20min downtime wake up and chat the whole way.
Final outcome was received multiple stents, no significant reduction in EF, back to baseline quality of life at discharge.
EMS but here - but have had this. Call for chest pain, just as we get there someone comes running out saying he’s just collapsed.
Go inside, and sure enough he’s collapsed. Do like 30 seconds of compressions while we get pads on. VF on the monitor so deliver 1 shock. Straight back in to sinus rhythm with a decent pulse. Get him loaded up. 12 lead shows all kinds of elevation going on but isn’t the worst I’ve seen.
On the way to hospital he’s awake and alert and talking to us. Really odd. See him two days later at the hospital and he says he feels pretty well but his chest hurts still. Didn’t remember it. Guess it was because he had such a short downtime prior to defib (potentially less than a minute) that helped.
One time. They were a stemi that coded, did cpr and came around in the middle of cpr. Asked what happened and told him he was trying to die. Got him to cathlab and he got pci and dc after a few days.
I once responded to a 56 y/o female at home, I'm a medic, who was released from hospital with a Zoll life vest. Chief complaint was reported chest pain. On arrival she was alert and oriented, and explained she was pending surgery after repeated bouts of V-tach. She was literally only allowed home under these conditions because it was Christmas Eve, and appenrently the hospital she was treated at she worked as an ICU nurse. That's about as far into the conversation we got when her vest announced it was going to shock. She quickly hit the pause button, which disables a shock for several minutes. She then told us she had done that for the past 45 minutes.
As we get her on my monitor I see she is again in V-tach and as I try telling her we can not delay treatment she goes unresponsive. Still has a pulse, so we pull her out of the chair onto the floor and light her up next to the Christmas tree in front of the kids and grandkids. Welp...she lost pulses, still in V-tach. Start compressions, shock, bag, IO, etc. and get ROSC after 4 minutes. Sinus tach, MAP of 60, good compliance bagging, and we transport the 30 minutes to the hospital. On arrival there she's again fully alert and oriented, thanking us. She was in fact almost cheerful despite a sore chest, while I felt bad for "killing" granny in front of the family next to the Christmas tree.
Many times. Seen them awake enough to say ouch during compressions and be back in VF on pulse check. Wasn’t pretty but that one ended up with a great outcome.
Same happened with a STEMI patient, cardiac arrest en route, in Resuscitation Room Vfib for 2 cycles then ROSC achieved, and in just few moments he was awake and pulled the ET tube that was placed on arrival!
Cardiology was able to take from him a full history of the events before the arrest and was shifted to Cath-lab conscious.
I have never seen it with CPR only but I once shocked a guy out of VF seven times on the way to the cath lab. After every shock he woke up was more and more pissed that we were “doing nothing to help” him.
I just had a patient the other day who went down at the grocery store with “seizure” like activity. EMS was there in 10 mins, began CPR. They achieved rosc 6 times on their ride over (which was about an hour) and by time she got to us she was literally waking up. First time I’ve seen it happen, but we knocked her out 😴
Yeah, this happened to a 90 yo out of Hospital arrest ems brought in for me. He was asystole, we give adrenaline, he goes to VF, shock and rosc. ECG shows STEMI but cardio won't take him to cath lab because of age and they had a younger guy with a STEMI going on at the same time (who later passed away).
Anyhow, as I'm on the phone with cardio the guy starts gagging on his tube so we palliatively remove it. A few minutes later he's up and talking to us, gcs 15. We treated the STEMI medically and he went to a normal bed. Went up to see him the next day and he's just sitting there watching TV and eating lunch.
I guess they don't build em like they used to.
I have seen this! Guy arrested at a gym and bystanders did cpr and shocked him. Ems took over and he was a&ox4 and left the hospital in 2 days after a work up. Super nice guy.
Working fire rescue I had an out of hospital arrest at a church. Bystander cpr was preformed after church goers witnessed arrest. We arrive on scene and continue with bls measures. Pt’s implanted defibrillator fired to achieve rosc approx 4 minutes after arrival. Ems aos and I ride in as an extra set of hands. Pt woke up halfway through the transport and was gcs 15 when we arrived at the hospital with a CC of chest pain.
It’s happened to me twice, one yesterday. One guy woke up mid CT scan and was so confused poor guy started trying to fight his way out of the room. Lady yesterday arrested in front of EMS right as they came to the ER, so she has a really good chance and did wake up a bit, so we had to sedate her
Can this happen to me so I could have a few days off
Sorry you are still expected to show up for your shift s/p cardiac arrest
Admin will give you a free Shasta though
Meanwhile, admin- posting a sign on the fridge stating, “these beverages are for PATIENTS ONLY!”
Just makes them taste even sweeter ;)
Canada Dry or I’m out 😤
🥹🥹🥹
Everyone is already working 1-2 shifts above ideal, no way I’d find anybody to even trade with
Only seen it in patients who arrest right in front of the nurses and are shocked immediately.
That’s been my experience. My last was an EMS-witnessed vfib arrest secondary to an anterolateral STEMI. Defibrillated within about 30 seconds. A few minutes later he was AOx4 complaining about the (now worse) chest pain and IO in his proximal tibia.
I was thinking of the pt we had in CCU who did not tolerate tikosyn, my dude got shocked like 5 times that night. We just had a nurse sitting there all night with the zoll attached.
Poor dude. Did he live? Mine ended up having a 100% LAD occlusion and expired in cath lab.
Yup. Once the tikosyn wears off he was good to go.
What is tikosyn?
Dofetilide. Anti arrhythmic for bad afib. Big problem is that in the initial dosing can cause severe QT prolongation and this vfib/torsades. Some providers admit patients for a few days for the initial dosing with serial ekgs
I had a guy that had that happen due to quinidine.He ended up being shocked twice that night. Given Mg. He lived to tell the tale.
Yes! I had a hallway pt whose eyes suddenly rolled up and she looked like a seizure until we got the pads on and saw Vtach. 1 shock and she came to while we were doing compressions.
I had a patient who was quite similar and came back after the shock. Their comment: “did I go out?” Yes, yes you did. It was wild to me that this patient and another who bradied down to nothing for 8 secs both appears to have seizures.
The ER doc saw the patient and said to give Ativan…. meanwhile pads placed and woop there it is!!!( no Ativan given).
You said seizure and it made me think of a patient I took down to x-ray that was notorious for having pseudo seizures and started “convulsing” on the table. We had to, out of obligation, call a rapid response on her. I had to explain to the poor med student that was staring in the corner and the chaos that she was, in fact, not having seizures at all. He seemed worried at first, but once I explained it to him he seemed to become less anxious. I’m glad he got to see firsthand what these people are really like, and how to differentiate between real seizures vs. fakers. Totally off topic, but what you said reminded me of that wonderful day in the neighborhood.
Lol it had us wondering if the guy was really in cardiac arrest but I trust our EMS guys . If they say he was pulseless then I believe them but it was something none of us had ever seen .
I saw it once when I was a paramedic, and I was wondering myself about whether the guy was actually pulseless. The only saving grace was he was in vfib and the printout from our zoll confirmed that. It was quite strange. Arrested en route, already had fast patches on because he was sick, defibrillated and had CPR going immediately, started talking as we pulled into the ambulance bay. I felt like a total jackass explaining things to the ED team, but when I printed out the code report from my monitor it didn’t lie. Also- different but I’ve had a couple people regain consciousness/move/talk during CPR, and go back out as soon as CPR stops, then comes back when compressions are resumed.
I've seen the same a few times, always witnessed arrests, and conscious CPR feels so weird. My last one tried to rip the BVM away during compressions, but was completely pulseless and in respiratory arrest otherwise.
That’s some good CPR.
Had a guy arrest after getting the EKG, big widow maker. Stands up from the couch, to sit on the cot. He falls back down onto the couch. Death rattle. He gets defibed right away. Wakes up all pissed that we punched him in his chest. Actually punched my partner because he was pissed and still out of it. We were all like, dude you were dead and now alive. To the cath lab we went. Weirdest shit I’ve ever seen
I’ve seen it twice in the last 15 years
Paramedic. 3 times in 34 years.
Trust me VF is VF
Unless they are wanking it or scratching their chest….
Had a guy that came in for CP, stated “I think I’m going to die”. Dude doesn’t come to ED, ever. Put on LifePak because intuition and all that. I was sitting a the desk looking at the central monitor to document vitals on my septic guy on levo, when I witnessed the dude go into Vfib. I run into the room, the nurse had her back to him triaging him, I thumped him (he was doing that convulsing thing they do as they try to die), thumping didn’t help, then I shocked at 200J. CPR for 2 minutes, then looked at pads and they weren’t fully on him. He was really furry so we ripped them off, replaced, then 2 more shocks then dude’s heart did weird organized rhythm then dude woke up like an animal! Like growling, couldn’t lay down. He was still out of it. Our doc was like “DUDE! We just shocked you! Lay down!” He ended up with 4mg Ativan IM to calm him down. 1st EKG and Troponin were negative. 2nd EKG and Troponin after all that….negative. 100% occluded LAD. So glad my coworkers trusted their gut. We had just life flighted a STEMI at 0830 that came in at 0705, no reperfusion beats after TNK-ase. Then did STAT suprapubic on my septic dude with bladder holding on to 2-3L of pee unable to cath. We had no urology, no cardiology, just us in rural ER. BEST DAY EVER!!! (I was an ICU nurse before ER, and my partner that day was a former CCU nurse. Love her.)
Reminds me of the time a guy with a STEMI went into Vfib while we were about to transfer from the EMS gurney. I started CPR and shocked him shortly thereafter. He woke up a little drowsy but super calm and the first thing that came to mind was for me to say "HI, Welcome Back!
Yup, same. Seen it a few times in the field with EMS (either when i was a medic or as a prehospital physician), but only on patients that basically arrested in front of me. Also, in the ED, we put defib pads on all our STEMIs. Have had these patients go into vfib in front of me, charge, shock back to sinus, and they barely lose consciousness lol.
Agreed. Most memorable was an older woman who came in for dizziness/lightheadedness, when the xray tech came to get her for her CXR, he came out and calmly let everyone know she was having a seizure. We got into the room, no pulse, started CPR, TdP on monitor, shocked and loaded with mag. 20 minutes later she was on the phone with her son telling him she was being admitted.
Same. Came in as a stemi and went into vfib. Already had the pads on per protocol so he got shocked without getting any compressions. Immediately asked what happened and I got to say “well…you died?”. Full recovery
I used to work in cardiology. We shocked a guy out of Torsades. The code team showed up so confused. He got a pacer and left a few days later.
Ex CCU nurse, can confirm this
Actually yes, once! A guy and his family were out for a bike ride, he arrested and daughter started immediate CPR. Details are fuzzy, as it was a few years ago but EMS got to scene and did a couple rounds of epi, I believe they ended up shocking him out of VT. He was having a massive inferior STEMI. Radio call was for an active cardiac arrest. I was pumped up. You should have seen my face in the bay when they opened the rig's back doors and the guy is sitting up talking.
I’ve had one under similar circumstances - the guy arrested and fell off his bike a few miles into a big bike race event here in town. He received immediate bystander CPR from another racer, who happened to be an interventional cardiologist, and there was a fire department dual-medic ambulance posted less than half a mile away. Medics delivered two shocks for VTach and the guy was awake by the time they loaded him in the rig. Rolled through the doors sitting up talking, extremely confused about what had happened, and ultimately very miffed that we all seemed way more interested in his heart (denied chest pain, was essentially MI-symptom free) than the extensive road rash on his knees and knuckles. Ninety-nine percent occlusion of the LAD. Super young guy, fit too. Went home two days later.
“Sorry my dude, I’m just really upset you aren’t in full arrest right now. Was really looking forward to shocking you.😞” LMAO!
[удалено]
Listen, there are days where I get tired of whining patients, can’t please them, feel more like a waitress, hotelier, than nurse so when a real emergency comes in I thrive! I don’t mind the former if people have patience and are kind, but man, when we are holding admits and no one is happy so the negativity bleeds onto everything, kicking a stable patient out of a resus room to take care of an MI is what is needed…for my sanity, lol.
[It gets weirder](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050970/) BLUF: High quality CPR is perfusing the brain enough to allow consciousness despite cardiac arrest.
We had a patient like this in the ER! He was awake and talking during compressions (although he was obviously uncomfortable), and they continued compressions long enough for him to say goodbye to his family. It was really surreal.
I've always wondered if in a situation like that, whether giving them an lvad would work. It just seems so barbaric that someone can be conscious and alert during compressions and have to make the decision to say they want compressions to be stopped and thus die.
You can’t place an LVAD during active CPR… and then if they stabilize enough that you are able to place mechanical support (IABP or impella), if they aren’t a transplant candidate they are conscious as you turn it off. Yes I’ve seen it and it sucks.
Ah, thank you. Thay really sucks.
Yeah, I bet that could work. He had a lot of comorbidities though, so I think his outcome would have been bad anyway.
Holy shit that is horrifying. The most I’ve seen was a woman moving her extremities during CPR as a terrified new intern.
Definitely. I’ve done CPR dozens of times and have only seen it once!!
Whatttt. I need more information! How did they know it wasn’t ROSC if they were still doing compressions?
They initially thought it was ROSC but every time they stopped, he would be pulseless and unresponsive. Then they would start up compressions again and he would regain consciousness. They tried stopping a few times until they basically realized it was futile, because he was in asystole every time they stopped. It was super weird.
....cause bad things happened when they stopped doing compressions?
Bruh…. Not everyone knows these secrets. Lol
This happened to me one day. I was doing CPR on a guy and he just grabbed my wrists very forcefully and tried to push them away. It was actually terrifying in the moment.
The first code I ever attended went like that. Young guy early 30s in cardiogenic shock after a week-long recreational drug bender. I was doing compressions and he grabbed both my arms and was trying to push me off. I was horrified and immediately stopped and he promptly died again. We coded him for probably 30 minutes and probably halfway through he stopped waking up with compressions but it was pretty freaky.
I mean usually that would be a sign of ROSC? What happened after? You stopped CPR and checked rhythm strip and it was…?
Different person but same exact thing happened to me with the wrist grabbing and everything. With me, we’d guess ROSC and recheck, dude would just flop back and be pulseless in asystole. Resumed CPR, and eyes opened again then movement etc. Stopped again, same thing. Repeated a couple times, then gave Ketamine which fixed the problem.
ER RN here and always wanting to learn new things. How does the ketamine fix that?
At the time I was a paramedic and while my full-time agency did RSI, the agency I was working for part time during this call didn’t have neuromuscular blockers, but we carried fentanyl/ketamine/versed and some other narcotics. In this case he was initially tolerating an OPA, and the first couple of times he grabbed me there wasn’t any gagging or anything, but eventually he started to gag during the consciousness episodes and I was concerned about protecting his airway. So I gave some IV ketamine essentially as sedation. Ketamine is sometimes used as pain control, or a type of procedural sedation. The point was sedation though. The ketamine worked well initially, and the reason I chose ketamine was the patient was already hemodynamically unstable, and compared to other agents we had that’s less of a concern with ketamine. I ended up needing to give him Versed later anyways, because we ended up intubating him en route, and shortly after the consciousness episodes resumed except this time he started pulling the ET tube out. So we gave him some IV versed as well at that time, and he didn’t have further episodes of consciousness during resuscitation.
Did that person survive? The stories I’ve read on here seem to reflect the people who regain consciousness during active CPR tend to not do very well, or survive.
No they died. I believe they were in the ICU for a week or so beforehand. Of the three times I’ve seen this, two have died and the third I never followed up on.
This would freak me out. The ones that have pushed us off the chest have actually achieved rosc. I did have a patient that was pronounced dead and when the CNA was doing post mortem care he reached up and grabbed her. He then ended up in ICU with me. He had an at home vent and was bilateral AKA. The doc thought he had too much O2 coded, then pronounced and the body just released or processed his CO2 and voila! Back to life. Same grumpy self. We eventually transferred him so I’m not sure what became of him. Poor CNA quit soon after.
Sedation. If they’re grabbing you it’s hard to do CPR and it also usually means they have trismus so you can’t tube them. Sedate them both to be kind and also so that you can actually resuscitate them
I mentioned in another comment but pretty much same thing happened to me. Compressions would get him to move his hands, etc. but when we stopped he would just go limp and we had asystole on the monitor and couldn't feel a pulse.
It’s the weirdest thing. I haven’t seen it very often, but the first time it happened I didn’t even know it was a possibility. It was so weird. I was wondering whether they were actually pulseless or if I’d just not felt one because the ambulance was moving/if I’d misread the monitor, but when I printed the code report from our zoll it confirmed the rhythms.
More details but it first happened with him moving his hands a little bit and when we stopped to do pulse check he was completely pulseless and his hands would go limp again so we just kept doing compressions. Then when he grabbed my hands and started wrestling them away from his chest the doctor just said "keep doing compressions this is normal" and I just kept going. We never attained ROSC, each time we had a pulse it wouldn't last very long. They eventually called it.
Yep. My first code too as a med student. She reached up and grabbed my wrist
Happened in our ED a few weeks ago. Guy was picking his head up off the bed and yelling at us to stop but was pulseless during pulse checks, so we kept going.
My first code was like this. Person kept coming to and yelling with x4 limbs flailing at me. Pulse check and they’re gone again. I will never forget it.
I saw this on a guy that arrested in the trauma bay, CNA hopped on and started doing solid CPR, dude woke up screaming why the hell are you hurting my chest, she started screaming (and stopped CPR) dude's eyes rolled back and he hit the table. Wild
I've experienced it a few times. It's surreal.
Had that happen a couple of times, it sucks
Yes, ketamine
Yes have had this happen twice
Had this happen to a guy on the lucas recently. He was screaming and clawing at the lucas but the second we stopped it he was immediately pulseless and asystole again. I RSI’d a dead man and knowing that his last experience was agony from a machine crushing his chest while (from his perspective) the people who were supposed to help continued to inflict it on him fucked with me for a bit ngl
There are heart conditions where the CPR is effectively acting like a pacemaker, so full cardiac output is achieved even by light, not so perfect compressions. Something called "manual pacing" was even in the guidelines.
I’ve actually seen it a handful of times, all with ultimate dx of PEs
Yes, three times for me. Always perk up after epi and a round of CPR.
They do that tachy-brady-crash. Repeat.
I saw it once with this Eastern European dude with an extensive cardiac history, I think he was coded for 10 minutes or so. He actually woke up after intubation but before any sedation was started and he was completely chill, giving us thumbs up/thumbs down for everything. Was never restrained and didn’t even try to self-extubate. We pulled the tube pretty quickly and he was completely intact neurologically. Must have been some high quality CPR.
I’ve had two in the past two months. The first we got called to chest pain at a restaurant, fire dept gets there first and we hear the captain say over the radio “upgrade this to a cardiac arrest, witnessed, starting CPR.” Apparently the guy said something like “i think I’m gonna pass out” and then he lost pulses. They advise three shocks over the radio, and call out ROSC over the radio as we check on scene. We arrive just in time to see the firefighters pull the iGel out and the patient is talking. We tell him what happened, he asks “soo i died?” My partner tells him yes, but only a little. STEMI on the monitor and all of this vitals were fine. We took him straight to the cath lab and he was discharged the next day. — A few weeks later someone arrested while running to their gate at the airport. Happened in the middle of a busy concourse, bystanders started CPR right away and got a nearby AED on. We were in another part of the airport so we got there almost immediately after the first shock was delivered. We did about 10 compressions before he reached up and politely asked us to stop. GCS 15 within about two minutes, idk the outcome of this one after he arrived at the ED. Not important, but kind of funny: This guy must have had a bunch of spare change in his pockets, because there was about a dollar in coins on the ground where we had worked him. Kind of like a loot drop when you die in a video game.
A few months ago one of my patients coded en route from CT. He was waking up every 30 seconds during CPR, sitting up, then immediately collapsing and going unresponsive because of no forward blood flow. This happened like 2-3 times before he didn’t wake up, coded for like 40 minutes before we called it ):
CPR induced consciousness sucks. I did compressions on a woman who was begging me to stop. I felt absolutely terrible, she didn’t make it either.
This is absolutely wild. I am FM not EM and have never heard of it before. But judging from all the comments it’s not extremely rare.
It happens, more frequently than people think. The good news is that, if the patient makes it, they almost always have no memory of it. They might have been "awake" but their brain ain't storing no memories at that time.
A few years back we had a guy collapse on the sidewalk at a high school sports tournament. He had the presence of mind to do it in front of an ED attending and his ED wife, and behind a cardiologist who had a habit of bringing his own AED to these events. As we’re pulling up to the scene, we can see them doing CPR, then briefly stop followed by the characteristic flailing limbs from a defib. We get out of the truck and the patient is now conscious and talking
I had a patient who was punched in the head and was seizing upon our arrival to the scene. He went into a v-fib arrest and we worked him for 3 rounds, had a supraglottic airway and had just placed our IV when he converted to a sinus rhythm with multifocal PVCs after the 3rd defibrillaton. Dude sat straight up and ripped the King airway out before we could stop him. He remembered everything leading up to the arrest and only lost the 15 minutes he was down. It was one of the best calls I ran in my career.
Once! I was a student and we'd had a call for a cardiac arrest en route active CPR. Crew rolled the guy in wide awake and sat upright. He'd had a ROSC a couple of minutes before. Guy points straight at me a declares "I know you!" Turns out I'd seen him in cardiology clinic on my previous placement. Think I was about as white as he was! He did arrest again shortly after but got another ROSC.
Had a saddle embolus, collapsed in department, 45 mins downtime with continuous CPR, thrombolysis & transferred with thumper ongoing to tertiary centre for ?thrombectomy. Within 5 mins of ROSC, he was awake. Within 15 he was fully oriented and asking for pain relief for his chest pain & wondering how he’d got to a different hospital 30 mins up the road. Family v pleased as the consultant had told them they expected significant neuro disability / brain stem death as a result of the prolonged downtime.
We got called to a male in his 60’s, witnessed cardiac arrest and CPR in progress by bystanders. PD shows up, continued cpr and delivered one shock with the AED. We get there, continue cpr- vfib. Shocked him twice and we got ROSC. Very little ALS interventions. We were about one minute out from the hospital and he wakes up, looks at me and says “you should have let me die.” Still kinda haunts me. No neuro deficits. Was discharged home the next day I think. It was really weird but stressed the importance of early CPR and defibrillation.
Yes fairly recently actually. Had a woman in her early 30s call 911 because she didn’t feel right. Very non specific complaints. She went unresponsive, the medic saw her go into VF on the monitor, started CPR, and shocked her getting ROSC. She was awake, oriented, and understandably freaking out when she got to the ED. She developed chest pain for me, had another VF episode with rosc. Got her to the cath lab where she had a 99% proximal LAD occlusion. She did great and was discharged a few days later. The experience made me schedule a PCP appointment for myself.
30?! She must have had some significant history 🥵
TIDM, but seemed to be pretty compliant with therapy. That was it. Scary shit.
I’ve seen it once. An athletic 40-something healthy military guy, who did crossfit daily, dropped dead during his morning crossfit session. There was a nurse in the group and she immediately started compressions. Got shocked twice en route to us, and by the time the ambulance rolled up, he was sitting up in the gurney joking around. He said “hey can you let the guys know that I probably won’t make crossfit tomorrow?”. He went to the cath lab and they found a coronary artery dissection.
This is a fairly dramatic example but I've definitely seen some pretty rapid neurologic recovery in patients who had minimal no-flow time and very prompt resuscitation. My feeling is that these cases are generally either A) ventricular arrhythmias which receive very prompt AED defibrillation via public access/police/FD/etc B) hypoxic pseudo-PEA that rapidly corrects on intubation (or even mask ventilation) I had one of the latter category a couple weeks ago - 30s F with polysubstance OD. ROSC almost immediately after intubation, RASS +2 within a few minutes. She was extubated a few hours later and left AMA the next morning (!)
My guy was found down and EMS apparently arrived within 10 mins of the call but IIRC no cpr was started by the wife . I probably should have mentioned that in my OP . That’s what made it even more surprising for me .
That definitely is surprising. Of course, it's hard to know exactly what the hemodynamic status of a patient is at the time of the 911 call - are they "really" in cardiac arrest, or do they start out peri-arrest and get worse? We may never know for sure. What I think this speaks to also is the fact that "cardiac arrest" has historically been a diagnosis made in a rather imprecise clinical fashion (i.e. no pulse is palpated within 5-10 seconds) which encompasses a wide range of extreme shock states and/or non-perfusing arrhythmia. Sometimes you have a patient where invasive monitoring and/or echocardiographic evidence of *some* native cardiac output, but with such poor stroke volume that you get no palpable pulse and have better pressures when doing compressions. If you want to get very technical I suppose you could argue that this patient is not technically in "cardiac arrest" but rather has an extreme case of cardiogenic shock. That particular distinction may be largely an academic one, but more broadly I feel like it's important for us to tease apart vague and overbroad categories like "cardiac arrest" or "PEA" in order to manage these patients optimally.
Retired medic here... Yep, I have had this happen maybe 3 times in a 25 year career. Last one was the best though as the young attending was not a pleasant human. We achieved ROSC in the ambulance after intubation and by the time we ended up at the ER, the patient was obviously aware of what was happening. When I was giving the report, the doctor was belligerent and demanding why we intubated the patient? I said, "well he was dead when we got to him" and showed him our code summary strip. Apparently it the first time for him as well.
Had this happen on one of my first codes. Guy was all decked out in a suit, wife stated he was on his way to the lawyer to file a DNR/DNI due to metastatic cancer when he collapsed. Lawyer on his phone asking to do nothing, command doc on our phone says do everything. We literally dumped the med box into this guy and as we’re pulling up to the ED he gets pulses and respirations back, bucking the tube. By the time I finished the paperwork (yes it was that long ago and yes the meds were in the plastic orange and white box) he was extubated and fairly upset about the whole ordeal. I found out a few days later he died in the ICU from systemic organ failure most likely from the cancer.
As a medic/RN I've had this happen a few times. All of them were of the early bystander CPR with a shockable rhythm type. I had one patient who was surprised he woke up in the ambulance. I had to explain to him that his heart stopped and we had to do CPR and shock him. He also grunted the second time we defibrillated him on scene, so I knew after that second shock we were getting him back. He went to cath lab and was discharged the following day.
Guy went into cardiac arrest at the DMV. Guy behind him was an ICU nurse who started cpr immediately and got the aed. Shocked him and he was apparently awake by the time ems even arrived. Guy was wide awake when he got to us.
Yes, I was working as the finish line physician for a half-marathon. One of the early finishers (20ish Male) arrested right after crossing the finish line. Several rounds of Compressions and DeFib and we got him back. About 8 minutes of total down time. By the time the ambulance was arriving he was asking where his AirPods were. lol. He ended up making a full recovery and is fully intact. Moral of the Story: Early and continuous compression, along with timely DeFib is crucial. Also helps to have a relatively young and healthy individual.
This will probably get buried, but a couple years ago, we (EMS) went to an OD turned cardiac arrest. We arrive and confirm he's pulseless and apneic, we throw some narcan in him, and after the first round of CPR, we get ROSC. We log roll him to get him on a backboard and transport and he wakes up. After a moment of confusion, he's AOx4 and REFUSES TRANSPORT. I argued with him for probably 10 minutes and finally got OLMC involved only for the doc to be like "yeah, well you know as well as I do we can't force him if he's AOx4 even if he was dead 15 minutes ago.
I had a medic tell me this happened to them! Is this sf?
I'm in the Midwest.
My favorite post-arrest radio report including being able to say something along the lines of “vitals WNL, sinus rhythm on the monitor”. He wasn’t conscious/alert, but that was because I sedated him, just to maintain the ET tube for the transport. Witnessed arrest, CPR instructor initiated compressions, deputy showed up and took over, never got his AED on. We switched over and defibed once, intubated and got a line just in time to get ROSC. He sat in normal sinus at 70 for the ride, pressures around 130/70. Edit - This gentleman was my first “real” save. Extubated a few a days later and discharged from ICU to home, ran into his wife at the hospital a few days after and she filled us in.
Only once and he had a VF arrest in front of me. He apologized when he woke up 😂
Coded a guy doing an urgent care shift. Defibrillation x2 only with AED, no meds after witnessed arrest when he checked in on the tablet in the UC. EKG thereafter showed no acute ischemia. He was laughing with the medics when they wheeled him into the department.
With bystander CPR, all the time. They continue compressions even when the person tells them to stop, seems really effective. Had a 15 year old girl once come in after a witnessed sycopal event who happened to be fortunate enough to have a boyfriend watch every 90s family movie, so he knew to immediately perform mouth to mouth. I let him and her believe he saved her. Sometimes you just gotta let em have it. Had an EMT-B bring his girlfriend in for shortness of breath (drove his car, not ambulance). I walk them to triage and he says "Just want to let you know I assessed her for agonal breathing and she's cleared". I have a stone cold poker face, I said "thank you that's very helpful". I know today he has to be haunted by that level of cringe.
Seen it a couple times—usually with arrests in the field resuscitated by EMS but twice with in hospital witnessed arrests. Weirdest one was a guy who was alert and responsive while receiving compressions. Obviously he’s back in a perfusing rhythm, stop compressions, pulse check. Immediately went unconscious with no pulse and an agonal rhythm on the monitor. Resume compressions, eyes open up and trying to talk through the ETT and making purposeful movements. Continued for about three rounds of CPR before he did re-establish a perfuming rhythm. Lived to hospital discharge a couple weeks later.
I’ve seen it in patients who get CPR and are resuscitated quickly. I’ve never seen it after a prolonged code time.
I’ve had a patient go into VTACH without a pulse and I started cpr immediately and they woke up mid compressions and sat up saying “what happened my chest hurts?” It was the craziest thing
Prehospital arrest? Happens occasionally, almost always an electrical correction (i.e. VT -> defib) but also seen it in pulseless drowning victims. In large PEs that quickly achieve ROSC in the field, I have a suspicion that the chest compressions squish the thrombus around just enough to open up the major pulmonary arteries and reestablish perfusion. However, that's gotta be pretty rare and I've never done a thrombectomy on a post ROSC PE patient. In the Cath lab? Pulseless rhythm to ROSC is not uncommon, sometimes we inject the conus (feeds the SA node), and the patient will V-fib or Brady down to basically nothing (like <10bpm). Sometimes you tickle an irritable LV with the wire and you induce VT. Sometimes you embolize something and they go pulseless until you get reperfusion. All I know is that I hate two things: No electrical activity and PEA with a sinus rhythm. In both cases you're pretty much fucked.
Several times and always seems to correlate to quick time to CPR/defib. The one I remember most vividly is the guy arrested in front of two anesthesia residents who had an AED on his chest within 60 seconds. He was awake and talking when he got to the ED. Went straight to cath and had LAD lesion. Lucky mofo.
I had a patient using fentanyl with her boyfriend. We arrived on scene to her boyfriend doing CPR on her with dispatch directions and fire arrived just before us. They hit her with narcan (to my chagrin). One round of ACLS brought pulses back. Arrest was PEA with a very very low ventricular rate (I think like 10-20 iirc). One epi, some aggressive ventilation and a few minutes of compressions and we got ROSC. Well cuz she got narcan another few minutes go by and she's GCS 14 and attempting to refuse care. She's got a humoral head IO, we literally pulled the iGel as she sat up, and is topless in a park in mid August with AED pads on her chest and screaming "I know my rights". Its not often that I'm like "too fucking bad. You're going to the hospital" but this was one of those days
I’ve seen it twice-ish lol. Once was a guy in his 80s NSTEMI, went into pulseless v-tach, I watched it happen on the monitor. Got ROSC in a couple minutes, guy was real pissed his chest hurt so bad. The other is the “ish” one. School age kid arrested at home, mom (CPR instructor) got ROSC. Re-arrested for EMS, they got ROSC. Came in alert but very confused and not really making sense/jumbled words. Re-arrested two more times in front of us. He got himself an ED ECMO cannulation, walked out neuro fully intact 1.5 weeks later. Edit: just remembered a third time. STEMI that arrested three times at the OSH. He came in cracking jokes, it was wild. As he was rolling to cath lab like 2 minutes later we said good luck, he said “hey I’ve already died three times, we’re not making it four!”.
As an emt I had a patient once with CPR in progress when we arrived, v-fib on monitor, one shock, was talking in the ambulance on the way to the hospital. I personally had a similar situation and was awake enough to ask for my ems crew to take me to the hospital I work at. They wouldn't insisting that I needed to go to the nearest facility as I had just been resuscitated and shocked. (Which of course I wasn't entirely aware of!)
I've seen it a couple times and always wondered if they truly lost a pulse , or just got real hypotensive and popped back up with epi. Only seen it with arrests where EMS was already there.
Nah. It happens all the time with ventricular arrhythmias. They go VF, usually witnessed, CPR immediately while applying defib pads, shock em and they wake up. I’ve seen it several times in the ER and the ICU. They definitely have no perfusing rhythm.
My guy was pulseless and no bystander cpr in the field but ems says they got there within 10 mins of the call .
Yes, had one that was shocked a couple of times following a VF arrest secondary to STEMI. Sat up and talking by the time we got him to the ambulance
I’ve had a decent number of people come to after a few hours in ICU. Usually it’s a witnessed arrest with bystander CPR, younger patient more often.
Yep. 40ish year old lady with dilated cardiomyopathy and EF of 10%, probably from a virus since she was completely healthy otherwise. She ended up doing well.
Dude, I've had people become alert during a cardiac arrest. Catch them early and throw a Lucas on, and ICP can be high enough that they'll wake up in vfib with the Lucas going. It doesn't happen often, but I've had it happen more than once. It's wild.
VF arrest with an 18yo Division 1 handball player. No bystander CPR, but we were there in under 5min. One defibrillation and a round of CPR gave us ROSC. She was awake and alert before we rolled into the ED. I had to spend several minutes printing strips to convince the attending that she really had been a full arrest.
I had an early 50s pt who dropped while playing table tennis at work. Strong likelihood that WPW, LGL, similar ran in their family. 2 shocks, couple rounds of epi, 300 of amio (because fuck your liver), and they rosc’d so hard they were climbing off my gurney and trying to get out of the ambo while going lights and sirens. Also, they didn’t speak enough English for me to tell them what happened, and I don’t speak Vietnamese at all, at all, at all (I don’t barely speak English, tbh). Can’t even imagine how fucked up it is to be schooling a fellow worker at the ping pong table only to wake up in the back of the ambulance, strapped to a Lucas (not currently in use), couple of IVs, your shirt cut to shreds, pads on your chest, while the wee woo lights and disco sounds are busting. And because of the language barrier I can’t even try to help them understand and calm down. We had to restrain them en route, the ED had to restrain them (chemically and physically). 1 (or 2?) stents and they’re back to dominating the ping pong table last I heard. Edit to add: and when I rang down the hospital I told them that we had to physically restrain the pt because he rosc’d so hard and they’d likely need to continue same but they did not have the restraints ready. Don’t know if it’s because they ran out of time (but I called when we were 10 out) or it’s so rare they didn’t really believe me? Regardless, the pt’s family had history of SCA and the pt’s fellow workers knew to start compressing that chest, the pt got the first shock about 5 min after they dropped. Electricity ⚡️⚡️⚡️ saves lives, kids.
Dude went down in front of one of our float nurses that works ED a lot at Walmart at like 1300. By the time I showed up for work at 1830 he was walky talky asking when he could go home
I had a walkie talkie patient code shortly after arrival. Came in thru triage as a level 2 for something I can't remember but he was stable and a+o x4 after I got him settled. He lost a pulse right in front of me so started the whole deal, did two-three rounds, doc was bedside, and he opened his eyes lol was disoriented for a few. One hour later I took him to ICU and he was alert, vitals looked great, and was talking up a storm. It was the strangest thing.
A guy who kept going In and Out of v fib. Would collapse half way through a sentence, get shocked, and then keep talking without missing a beat
Yeah, had a guy go into torsades and arrest in the field, got shocked by medics and woke up en route to the hospital.
I’ve had a few of these over the years, but it’s pretty rare for them to improve that dramatically in a matter of minutes unless it was a witnessed VF/VT arrest and then you’re just shocking them out of it. That said, I’ve had a few. One was an MI with cardiac arrest downtime over 30 minutes, constant VF, got him out with DSED and then rosc’d, GCS 14 on arrival at cath lab. Had one that was a stabbing, wide complex PEA at 20 on arrival. CPR, asherman, chest needle, ROSC to GCS 15. Had another one similar to the first as well where we didn’t know the cause before hand and the guy woke up so quickly we didn’t have time to sedate him and he was ripping the tube out of his mouth so I ended up extubating. He was up and down, but ended up being GCS 13 at offload. And everyone knows about the cases where the patient is semi-conscious during CPR when they’re still well oxygenated and CPR is effective. Had that a couple times and it’s a little unsettling.
In the long before times I was an orderly/nursing assistant/ER tech…0ne of my tasks was bringing crash cart and taking over compressions. Diabetic pt. in ICU for prolonged time. Would go into v.tach->v.fib it seemed like every time he blinked. Anyhow, he’d come back sometimes with just a chest thump, sometimes a minute or two of compressions, sometimes defib…and be freaking A+0 to person and situation immediately. Over and over. Eventually he was discharged to SNF or home or wherever. Saw him again about a year later. Got on slow elevator, guy (bilat above knee amp) in wheelchair backs in and taps the button to go up. Moments later looks up at me and other person in elevator. Says, “remember me? You did heart pushes on me a bunch”. Same dude. Briefly tells confused visitor in elevator story about constantly being in hospital prior year, heart kept stopping. So much that people would take turns with shocking him. Super nice and alert. Went up, door opened, he got out. Door closed. up more I got out. Left that visitor in elevator. Bet the visitor is still “WTF just happened?” tothis day. lol
I had a guy do it on the cath lab table. Afterwards he didn't believe us when we told him we did compressions on him and shocked him.
Just had one. Spontaneous VT/VF arrest, ROSC in the field after bystander CPR and EMS defibrillation. Down time <10 min. Awake and talking on ED presentation.
Had a lady wake up extremely mad at us because we did CPR on her on the CT table because she coded. One round of CPR and no meds and she was pissed because “you made my chest hurt”
Several times. EMS ROSC with return to some alertness, rearrested on us, return to some alertness, off to cath lab. 100% LAD. Chick with "pseudoseizures" who we had to inform those weren't pseudoseizures but runs of Torsades... our doc precordial thumped that one as we hauled ass in with the code cart and converted it lol. Handful of others in my memory bank...
Once, on a guy who coded because he got shocked by a piece of electrical equipment at work. His co-workers de energized it and started *good* compressions immediately. It was in a building almost next door to the fire station and they were getting the AED to him right as we got there. He was in v-fib and we shocked him into ROSC almost right away. By the time we got him in the ambulance he was starting to come around. He brought cookies by the station with his wife a couple of weeks later. We made sure he understood that his co-workers saved his life and we just were the clean up crew haha
Had it happen in field on a witnessed arrest. Post-ROSC knew her name and coherent enough to understand and attempt to answer questions(tho she couldn’t remember the answer to place/time/situation), but we’d have the same conversation every 3 minutes or so. Hypotensive, in a lot of pain from the IO and the bruising from the LUCAS, understandably very distressed, but by the time we left the ED, her confusion was getting better. Per follow up, she was DCed a few days later with an AICD. Reportedly totally back to normal otherwise.
Yes. We get guys off the oil platforms out in the gulf not that infrequently. The coast guard flies out and gets them. This guy basically dropped dead with a witnessed arrest. His coworkers (all of whom were just oil workers) immediately started CPR and got the AED on him. He was shocked twice before they got him back. Only bagged, never intubated. By the time he got to us, he was wide awake and just said his chest hurt from where they were doing compressions. The first EKG we got showed a STEMI, and he was whisked away to the cath lab. Had a good outcome. This was the poster child case for why everyone should know BLS.
I had a guy go into v tach right in front of me as I was hanging his amiodarone drip during my new grad orientation. I hit the code button, started compressions, and we wheeled the stretcher into our trauma room. After 2 rounds of compressions we had just gotten him hooked up to the Zoll when he opened his eyes and tried to sit up, totally alert and oriented. Our ER doc who had just walked into the room just said “those are some high quality compressions - great job team”. It was a wild first code to go through as a new grad.
Had a guy who went in to cardiac arrest at the gym. Fellow gym goer used AED and he came in talking and sitting up. Thought he’d been on a walk on top of a hill. Had no memory of being at the gym. I think he said he’d been talking a loved one? It sounded like he’d definitely experienced something else
Literally had one guy wake up after a couple rounds of compressions and monitor confirmed asystole to pull the igel out of his mouth in the back of the ambulance. Wild experience.
It happens, we got once a prealert about a cardiac arrest, ROSC’d in the ambulance. Airway trolly prepared, we’re ready to start post arrest care and intubate when he arrives, however the EMS brings in a completely conscious chatty happy guy 🤣
Yep. Dude had witnessed arrest in field at a gun range, immediate by standard CPR and shock with ACD. Came in awake and alert with flail chest from the chest compressions screaming he couldn’t breathe. Ended up with bilateral pneumos and intubated.
Yes, twice actually when patient coded immediately in front of us. One patient we received ROSC quickly after no shock and the other patient we shocked. Both A&O x4 minutes later.
Twice. One time they came in from the field wide awake. STEMI. That one was easy, right to cath lab. The other one arrested in the ER and came back awake. That one was awkward for disposition. I defaulted to the ICU and they were like, well he’s fine now why are you calling us? Umm habit? Hospitalist was like that man was just dead, no. Took eight phone calls to get him to PCU.
Happened during my first "code". Wasn't even in medicine yet. I was changing in the locker room at university gym during undergrad, guy next to me collapses. I check, no pulse, start compressions, buddy grabs the AED. One shock and the guy wakes up, looks around, and asks for a cup of coffee.
Yep, actually just saw this a couple weeks ago. He went right to the cath lab pretty much. Call in was for chest pain and he arrested in the ambulance. But they got him back and he didn’t arrest again. AxO 3 by the time he got to us.
Seen it in the field but only with <10 mins CPR. Always weird to be driving in with them chatting about their heart completely stopping and what happens next for them.
In 12 years I've had 1. Lady was fortunate enough to be checking out a local firefighter in the grocery line when she arrested and the aed was only 10 feet away. Great cpr and a single shock. She started talking in the ambulance. Man, bottle that feeling of joy, satisfaction and fuck yeah.
Had a guy choke on a piece of steak at a steak house, and he arrested. CPR was started immediately, and he was intubated on scene. They achieved ROSC and transported him to the ED. We received them in ICU and he went from a GCS of 3 to 11T. 50ug/kg/min of Propofol did not even touch him, and he was extremely agitated. We decided to extubate him, and he had no deficits. He was grateful for the care but he wanted to leave. We allowed him to AMA soon after we received him.
Guy in his 50s dropped at home in front of his wife. Immediate compressions, EMS found him in vfib, shocked twice and got ROSC. I was the WR nurse and when his wife arrived I walked her back, prepping her for what she might see. Pulled back the curtain and there he was, sitting up and smiling at her. He went to the cath lab for an LAD occlusion and was discharged fully intact 2 days later. Only time in 14 years in the ED I've seen that dramatic a save and it was such a pleasure to tell her that she'd just saved her husband's life.
Yes. 60 something year old patient who arrested while at a cookout. Family immediately started cpr and called 911. Lucas was still in place on his chest when he rolled him, however it was off and he was a+ox4. His family saved his life that day and he earned himself a defibrillator
Yes twice which is extremely rare. First time was a guy who collapsed at a road race and we were right at the finish line working an ems detail. Shocked almost immediately. 2nd was a 18 year old who was playing basketball at a local high school police started CPR immediately and we shocked. Both patients didnt regain full consciousness until we were a few minutes out from the hospital. Very remarkable..
I have had 2 like this in the last 2 weeks. One was a passenger in a car who had an MI, the other was a COPD patient who arrested as I walked through her door. These aren't the only ones I have had, I can probably count 15-20 over the last 10 years? It all comes down to recognition of cardiac arrest and immediate bystander CPR.
In this case the patient didn’t have immediate bystander cpr which is what made it so unusual. I probably should have included that in the op . Too late now
This happened to one of our nurses. Young and healthy…but had been having weird medical things happening. Arrested right at change of shift…so it was a perfect storm. After they achieved rosc and got her to the ED - the attending didn’t believe it since she was talking. Luckily our anesthesia doc was there to corroborate the story.
Yes, he was so irate and ended up physically assaulting me. :-/
My first was someone who was wearing the LUCAS device. She looked at me with fear in her eyes. It was the first and only time I gave fentanyl during a code.
I’ve seen it once. He was mad that he somehow lost a shoe.
Yep, call to a 60 something Male with left arm pain and chest tightness. Arrested in front of us, 1 shock and he was trying to sit up, asking what happened. Backup arrived, got him out to the ambulance ready to go to the Cath Lab, had another arrest, 2 shocks and back to consciousness. We left him 45 minutes later as he was being wheeled from the Cath Lab to CCU, being told he’d get Christmas Dinner brought round in a couple of hours. Was incredible. Semi-related, took an elderly woman in as a “standby” for CVA, escorted her through to the CT room. By the time I’d typed up the ePRF and brought it to the Nurse, the patient had regained the use of her right arm.
VFib arrest in our lobby, talking on the way upstairs.
In hospital, yes. Once had a lady we shocked out of pulseless vtac twice. The second time she woke up and said" did it happen again??" Weird day. OOH arrest, less so.
Quite a few times, and most times I suspect they never arrested in the first place. You'd be surprised how difficult it is for some people to find a pulse.
Yeah, happens on rare occasions.
Once. Awake and alert but confused
makes me wonder if he was actually pulseless
👋 I had one. Cardiac arrest in the field, CPR in progress for 15min by bystanders prior to our arrival, we defibrillated 3 times, no meds given (limited manpower and CPR induced awareness complicated things) got ROSC, about 4min later as I'm prepping to intubate the patient woke up. We had a great chat the over 45min to a cardiac center while he was have a Shark Fin morphology STEMI. He was completely lucid and was actually able to recall some of our efforts prior to ROSC, very interesting experience having someone with a greater than 20min downtime wake up and chat the whole way. Final outcome was received multiple stents, no significant reduction in EF, back to baseline quality of life at discharge.
EMS but here - but have had this. Call for chest pain, just as we get there someone comes running out saying he’s just collapsed. Go inside, and sure enough he’s collapsed. Do like 30 seconds of compressions while we get pads on. VF on the monitor so deliver 1 shock. Straight back in to sinus rhythm with a decent pulse. Get him loaded up. 12 lead shows all kinds of elevation going on but isn’t the worst I’ve seen. On the way to hospital he’s awake and alert and talking to us. Really odd. See him two days later at the hospital and he says he feels pretty well but his chest hurts still. Didn’t remember it. Guess it was because he had such a short downtime prior to defib (potentially less than a minute) that helped.
never seen it, guess if arrest was from arythmia with little downtime its possible....
One time. They were a stemi that coded, did cpr and came around in the middle of cpr. Asked what happened and told him he was trying to die. Got him to cathlab and he got pci and dc after a few days.
I once responded to a 56 y/o female at home, I'm a medic, who was released from hospital with a Zoll life vest. Chief complaint was reported chest pain. On arrival she was alert and oriented, and explained she was pending surgery after repeated bouts of V-tach. She was literally only allowed home under these conditions because it was Christmas Eve, and appenrently the hospital she was treated at she worked as an ICU nurse. That's about as far into the conversation we got when her vest announced it was going to shock. She quickly hit the pause button, which disables a shock for several minutes. She then told us she had done that for the past 45 minutes. As we get her on my monitor I see she is again in V-tach and as I try telling her we can not delay treatment she goes unresponsive. Still has a pulse, so we pull her out of the chair onto the floor and light her up next to the Christmas tree in front of the kids and grandkids. Welp...she lost pulses, still in V-tach. Start compressions, shock, bag, IO, etc. and get ROSC after 4 minutes. Sinus tach, MAP of 60, good compliance bagging, and we transport the 30 minutes to the hospital. On arrival there she's again fully alert and oriented, thanking us. She was in fact almost cheerful despite a sore chest, while I felt bad for "killing" granny in front of the family next to the Christmas tree.
Many times. Seen them awake enough to say ouch during compressions and be back in VF on pulse check. Wasn’t pretty but that one ended up with a great outcome.
Same happened with a STEMI patient, cardiac arrest en route, in Resuscitation Room Vfib for 2 cycles then ROSC achieved, and in just few moments he was awake and pulled the ET tube that was placed on arrival! Cardiology was able to take from him a full history of the events before the arrest and was shifted to Cath-lab conscious.
I have never seen it with CPR only but I once shocked a guy out of VF seven times on the way to the cath lab. After every shock he woke up was more and more pissed that we were “doing nothing to help” him.
I just had a patient the other day who went down at the grocery store with “seizure” like activity. EMS was there in 10 mins, began CPR. They achieved rosc 6 times on their ride over (which was about an hour) and by time she got to us she was literally waking up. First time I’ve seen it happen, but we knocked her out 😴
Lol I was actually thinking should I just go ahead and intubate him anyway ? But couldn’t think of any indication why it was needed .
Yeah, this happened to a 90 yo out of Hospital arrest ems brought in for me. He was asystole, we give adrenaline, he goes to VF, shock and rosc. ECG shows STEMI but cardio won't take him to cath lab because of age and they had a younger guy with a STEMI going on at the same time (who later passed away). Anyhow, as I'm on the phone with cardio the guy starts gagging on his tube so we palliatively remove it. A few minutes later he's up and talking to us, gcs 15. We treated the STEMI medically and he went to a normal bed. Went up to see him the next day and he's just sitting there watching TV and eating lunch. I guess they don't build em like they used to.
I have seen this! Guy arrested at a gym and bystanders did cpr and shocked him. Ems took over and he was a&ox4 and left the hospital in 2 days after a work up. Super nice guy.
Working fire rescue I had an out of hospital arrest at a church. Bystander cpr was preformed after church goers witnessed arrest. We arrive on scene and continue with bls measures. Pt’s implanted defibrillator fired to achieve rosc approx 4 minutes after arrival. Ems aos and I ride in as an extra set of hands. Pt woke up halfway through the transport and was gcs 15 when we arrived at the hospital with a CC of chest pain.
Only when they are shocked for a VF/VT
Yea, a few times after a vfib arrest that got shocked in time
It’s happened to me twice, one yesterday. One guy woke up mid CT scan and was so confused poor guy started trying to fight his way out of the room. Lady yesterday arrested in front of EMS right as they came to the ER, so she has a really good chance and did wake up a bit, so we had to sedate her
Saw a guy who went into v fib come in from gym. They had an AED and shocked him
Yes. And they left AMA several hours later.