Cardiac Arrest

Patients and their relatives don't have a clear idea what CPR entails. It rarely succeeds and is brutal... this post is an account of how a typical arrest scenario unfolds.

Anton stood in the doorway of his hospital sideroom. He wasn’t sure how he got there, considering he was in bed seconds ago writhing in pain. He knew he was sick, but for whatever reason he was now pain free.

“Anton?” whispered the voice of a nurse behind him. He tried to turn around, mystified by why everything was all of a sudden so slow. He felt his movements were dictated by an inexplicable inertia. With sluggish effort he managed to face his bed.

“How peculiar”, thought Anton. Lying in the bed was Anton himself. There was no mistake about it, that sallow figure lying motionless and silent was himself. It was tucked tightly in bed, its head tilted back and its mouth gaping open. Anton cringed as he saw that a sliver of drool had meandered down the gaunt, jaundiced face onto the pillow.

Arched over it was Eva, the nurse who took care of him. “Antoooooon!” she cooed, pinching the shoulder. Achieving no response, she pulled the covers back and saw it wasn’t breathing. Anton had seen this scenario enough times to realise what was going to happen next and it terrified him. He wanted to step forward to stop Eva pressing the emergency button, but also to slap some life into the body. His legs wouldn’t shift, as though cast to the linoleum floor with lead. He tried to shout, except his mouth wouldn’t open.

On hearing the alarm, the room was flooded by ward nurses and doctors. They rushed in past him. None seemed to acknowledge he was there. Eva had already started chest compressions. She had torn open the pyjama top. Her interlocked hands pulsed on the sternum, as though on a trampoline. Judging by the way the chest sagged asymmetrically with each blow; Anton could tell Eva had broken some ribs already. He winced as Eva leaned over and was putting more effort into her compressions. Another nurse had brought in the crash trolley. Anton could tell this was her first time; she took a step back and anxiously watched the calamity in front of her unfold, a hand over her mouth.

A burly doctor had taken over chest compressions from Eva. Anton could tell he was pushing all his weight into it; each compression now accompanied by a hoarse, grunting wheeze from the body. At first it all looked a shambles. Beeping machines competed for sound with shouting doctors, their voices shrill with adrenaline. The TV was still on, an episode of “Dinner Date” playing. Blood was dripping down an arm, and the unmistakable smell of urine and excrement shrouded the body. The compressions continued, a pinkish froth foamed and crackled at the mouth. A nurse had connected the defibrillator, but the screen wasn’t working.

Yet within seconds, it all changed. Anton could see that this was an organising entropy, chaos on a leash. The medical registrar tinkered with the defibrillator and it worked. She took a step back, her arms folded and her eyes surveying the scene in front of her like an army general. A doctor had pulled down the body’s pyjama trousers, exposing the groin and feeling for a pulse. At the same time, on the other side, a doctor was crouched on the floor inserting a cannula into the hand. Anton was shocked by the size of both syringe and cannula, but could do nothing to stop the doctors simultaneously stabbing with the needles; the syringe filling with crimson and the cannula sliding under the skin. The syringe was quickly handed to another doctor, who ran out of the room to process it.   With the cannula in, the other doctor immediately pushed a syringe full of adrenaline through.

At the head of the bed, the anaesthetist was negotiating the body’s airway. It was only 27 years old, and the anaesthetist knew that he would need to put a breathing tube down. It was difficult; the head was bobbing up and down with each compression and there were plenty of secretions in the mouth. With one hand he tilted the head back, his other hand slid an L-shaped device down the throat. Once wedged in, he tugged upwards, at the same time crouching behind the head and looking into the mouth for a clear view. The airway was barely visible, and he had to tug harder. The metal scraped against the front teeth, and they chipped as they knocked against it. “There it is!” he shouted, a nurse handing him the breathing tube. He slid it in and secured it, connecting it to a green bag and oxygen tubing.

“Pulse and rhythm check!” announced the medical registrar. The compressions stopped. The burly doctor was visibly exhausted, his scrub top a darker shade of blue with sweat. His colleague volunteered to take the next set and put his fingers on the carotid pulse. The anaesthetist squeezed the green bag, the chest rising in response. For the first time, there were seconds of near silence as all eyes were on the defibrillator screen.

“We’re in VF, get back on the chest” announced the medical registrar, her stance unchanged, her voice cool. She turned towards the doctor who had put the cannula in. “Alice, you ok to shock?”, She nods in response and stands by the defibrillator and changes the settings. Compressions started again, the anaesthetist pumping the green bag.

Alice faced the team, her thumb on an orange button. “Charging!” she says, followed shortly by “Off the chest, oxygen off!”. The compressions stopped again, the anaesthetist disconnected the oxygen and stepped away. All was silent except for Dinner Date. Alice looked around and then firmly pressed the orange button.

Anton’s eyes widened as he saw the body pulse, the chest violently wrench forward and drop of its own accord. His own hope for success, for some sort of positive resolution of this barbarity was mirrored in the eyes of the doctors and nurses as they looked at the defibrillator.

“PEA. Back on the chest, adrenaline!” said the medical registrar, her hands now at her hips. Compressions started again, another syringe of adrenaline given. “When was this going to end?” thought Anton, the body in front of him pale and deformed, living only through the efforts of the men and women around it. He was shocked at an almost infinite resolve, their efforts not waning despite the circumstances.

The doctor who had rushed off with the blood test had now returned, running in with a sheet of paper. He gasped for air as he handed the result to the medical registrar who devoured it with her eyes. She read out the results, with particular emphasis on the pH and lactate. It must have been bad, as one of the doctors groaned. “This is it”, thought Anton. “This is when they give up”.

“We carry on” said the medical registrar. “We haven’t identified a reversible cause yet, but it looks like he was under the surgeons with abdominal pain. Let’s give him some fluid stat and get them down here. Sounds like they were worried he had ‘perfed’ and was septic. He’s awaiting a scan”

With that announcement, everything suddenly stopped. It was like a game of musical statues, everything and everyone was static. Even Dinner Date was paused. “What now?!” wondered Anton. 

He stared at the scene in front of him like it was a wax-work display. It was all so intense. This indefinable, grey area between life and death was a human invention. Which side of the line was he falling towards? These tireless men and women seemed intent on pulling him back. For what? Was he worth it?

His life was pretty unremarkable. He struggled to find his place in the world and this haunted him incessantly. He couldn’t justify his existence. It’s not like he ever wished he was dead... it’s just he always thought if death came to him he wouldn’t have minded so much. Life was persistent, never ending and unrelenting and here was a way out on a plate.

Anton looked at the frozen medics in front of him. He liked the medical registrar, her posture oozing in confidence. The doctor doing compressions was leaning over the body, his face contorted with effort. Eva was holding up a bag of fluid, she had managed to put it up even before the registrar had suggested it.  This scenario was more than ‘just another day at the job’ for these people. There was nothing enjoyable about any of this, yet they obviously put in all they could. It didn’t make sense beyond a sense of duty towards the patient, towards saving a life.

Maybe that’s what life was all about; it didn’t necessarily make sense but you did what you could to preserve it. These people literally waded through bodily fluid to try and save his. They obviously valued his life more than he did. This was enough to make him realise what he wanted.

With that thought the present resumed. The chaos of CPR continued. The medical registrar was looking at the defibrillator, “Pulse check! I think we’ve got a change in rhythm”. She was right. The fluid seemed to have done the trick along with the adrenaline; he was now in sinus rhythm. A wave of relief rippled across the room, and manifested in all the faces there. It warmed Anton to see them all relax, the medical registrar putting them at ease by saying “Well done team”. You could tell it didn't usually end like this.

Although compressions had stopped, the team carried on working. The surgical registrar arrived and furnished a plan. The ITU consultant had also arrived and was in conversation with the anaesthetist at the head of the bed. He was still pumping the green bag. Another doctor was putting another cannula in, whilst another anaesthetist had started putting a line into the radial artery. The medical registrar had left and was seated at the nurses’ station documenting. She was talking to a medical student at the same time, explaining that Anton was lucky. He was young and had a reversible cause for his cardiac arrest. The four other cardiac arrests that week had ended differently. Her conversation was interrupted when her bleep went off and she went to answer it.

That was the last thing Anton remembered before waking up in ITU. They had taken the breathing tube out and were cautiously waiting to see how he was going to do. He had been there for one week; a perforated ulcer confirmed on CT Scan was operated on the day after his arrest. 

He didn't care. He was alive and relieved that was the case.