Surprisingly it took me over 2 years to be actively involved in a code blue. Timing has just always been on my side, and until now I’ve seemed to avoid (if not possibly prevent) codes. I am fully trained in ACLS and CPR, but I wasn’t expecting this.
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About a week ago one of our monitor techs suddenly started screaming that a patient was ringing out asystole. We all ran into the room to find an already pale patient, completely unresponsive, and called a code blue. I was the second person to start compressions, and immediately I could hear and feel the ribs begin to crack and pop in the chest. After a few minutes I believe I had probably broken about every rib, and was relieved by a coworker to catch my breath.
The patient was soon intubated, and the respiratory therapists were suctioning copious amounts of blood from the lungs as we had no doubt pierced them with the all the broken ribs.
Maybe 10 minutes later, I later found myself doing another round of compressions, and by this point the entire chest was squishy without form. The crowded room was near silent aside from the sounds of the blood gurgling in the ET tube, the monitor ringing out, and the rhythmic squeaking of the bed with each compression.
Deep down, we all knew we weren’t going to get him back, and around the 30 minute mark we finally called the time of death. He never regained consciousness or entered a shockable rhythm.
Despite this, it was actually a very well run code. We did everything by the book and the atmosphere was surprisingly calm and well coordinated. I was very proud of our team.
As the adrenaline began to subside I pondered whether or not we had done more harm than good. Even if we had managed to resuscitate the patient, he surely would have died anyway from the extensive trauma we inflicted to his thoracic cavity.
By the end, his chest was nothing more than a mushy blob, with palpable pockets of blood slowly forming pools on his back. Do elderly adults understand what they are signing up for when they ask to be a full code?
Statistics show that despite a small percentage of successful resuscitations, the vast majority of these patients will still die in the hospital from complications of their cardiac arrest. In a study looking at code blues performed in hospitals on 290 patients with an age range of 3-78, less than 31% survived the initial CPR. Furthermore, only 12% lived to be discharged. In addition, CPR lasting over 10 minutes was associated with significantly higher mortality rates.
I still believe that as a young healthy adult, a full code is a wise choice. But specifically for frail elderly patients, perhaps 80 years of age and greater, I don’t see the point. Some people’s bodies just can’t tolerate the aggressive treatment that is CPR, let alone a GLF without dying in the hospital. The slight delay of death is often associated with unnecessary suffering, pain, and anguish.
Personally, beyond a certain aging point I don’t think CPR compressions are worth it (for most hospital patients, but there are exceptions to every rule). Even if the cardiac arrest doesn’t kill you, the code likely will. It is for this reason I will likely be a partial code when I’m an old man. I am okay with defibrillation, meds (for any good they may do without compressions), and short term intubation.
I’m holding out for nano-bots and gene therapy to be the future of medicine. One day CPR will probably look like something barbaric from the stone age, but for now, that’s where I’m drawing the line. I will be sure to share my experience with my friends and family to help aid them in making an informed decision, and hopefully spare others from a similar fate.
Update: I have been in many additional codes since this article was written. We have gotten maybe around half of the patients back and sent them off to the ICU, but I maintain that past a certain point of aging, this is a pointless exercise. Most of them have not survived to be discharged. Each situation is different, and I cannot state a one size fits all age for recommending DNR status, but if a patient is not likely to survive CPR, nor recuperate fully or near fully to be discharged in any decent state, then I do not think it is a good idea.