Many things come to mind. I had a patient who could repeat what was said during his CPR. I attributed it to a state of minimal consciousness produced by chest compressions. There must have been enough brain perfusion to listening, but not to moving limbs etc.
The experience made me very conscious of what is said during CPR attempts. I regularly remove from the room /ICU box people who keep talking and playing 100-beat songs. I hate that. This is a sacred moment.
Third point, patients receiving ketamine may have a disembodiment experience. I think it allows a biological perspective on the phenomenon.
I'm going to post these, just to see what others may have experienced. First, though, I agree with Dr. Dams, plus I love your subtitle. In a 43 year career in medicine, there have been two instances where I KNEW that people were conscious during CPR.
The first was during my internship, in April and in room 4314 of Bell Hospital (do you think this has stuck with me?). As was my wont, when I heard the overhead Code Blue page I ran to the room and was the first doc there. I ascertained that the lady was definitely unresponsive and pulseless and, with the nurses having already hooked her to the monitor showing v-fib, after a couple of shocks I grabbed an ET tube and intubated her as they started CPR. With every round of compressions she would open her eyes and push us all away. Thinking that she must have achieved ROSC, we would stand back and she would immediately go unconscious. Fairly shortly we did achieve ROSC and moved her to the ICU. She wasn't my patient, and I never got to talk to her about the experience. Nevertheless, she was conscious on some level, I am sure. Not conscious enough to understand the circumstance, but enough to feel that she was being attacked, it seems.
The second time was about 14 years later, and it involved a little 60ish year old lady with MS who we had ventilated with septic shock and ARDS for about 4 weeks. She also went into v-fib arrest, this time witnessed, so CPR began immediately. When CPR was ongoing, she pushed us away. Repeatedly. We were never able to achieve ROSC. After a prolonged arrest, and after using every tool at our disposal, I finally had to call the code. In this case, I swear she was looking at me while awake and telling me "no". That part could be in my imagination. Nevertheless, she was awake enough during the arrest. That was 28 years ago and obviously also has stuck with me.
Anyone else have similar experiences? I just wonder if we all have.
At right near 46:19 is a story that have not forgotten. WORTH IT. The doctor tells it beautifully, but it's sort of haunting -- basically the patient undergoing arrest is able to ascertain the inner thoughts of the intern performing the cpr!
It's not the best audio but listen if you'd like it's a great conversation from experts in this space.
I recall I was a first-year res rotating on a medical service when we had a Code Blue in the wee hours. The patient was extremely large and not that old. As the upper-level trainees filtered in the room, the groans and comments began. "aw, man! She's a friggen"whale! Just push her back in the water! Don't cover thw blow hole"1 Etc. Etc. I felt embarrased by the banter and kept my moth shut. She was still someone's mom, sister, wife, grandmother, etc., we wouldn't do that if they were in the room. The patient opened her eyes briefly and said "You're all laughung at me because I'm so fat!" then colsed her eyes and expired. We all felt like total shmucks.
I like your last sentence, makes one think about life.
Many things come to mind. I had a patient who could repeat what was said during his CPR. I attributed it to a state of minimal consciousness produced by chest compressions. There must have been enough brain perfusion to listening, but not to moving limbs etc.
The experience made me very conscious of what is said during CPR attempts. I regularly remove from the room /ICU box people who keep talking and playing 100-beat songs. I hate that. This is a sacred moment.
Third point, patients receiving ketamine may have a disembodiment experience. I think it allows a biological perspective on the phenomenon.
Great post!
I'm going to post these, just to see what others may have experienced. First, though, I agree with Dr. Dams, plus I love your subtitle. In a 43 year career in medicine, there have been two instances where I KNEW that people were conscious during CPR.
The first was during my internship, in April and in room 4314 of Bell Hospital (do you think this has stuck with me?). As was my wont, when I heard the overhead Code Blue page I ran to the room and was the first doc there. I ascertained that the lady was definitely unresponsive and pulseless and, with the nurses having already hooked her to the monitor showing v-fib, after a couple of shocks I grabbed an ET tube and intubated her as they started CPR. With every round of compressions she would open her eyes and push us all away. Thinking that she must have achieved ROSC, we would stand back and she would immediately go unconscious. Fairly shortly we did achieve ROSC and moved her to the ICU. She wasn't my patient, and I never got to talk to her about the experience. Nevertheless, she was conscious on some level, I am sure. Not conscious enough to understand the circumstance, but enough to feel that she was being attacked, it seems.
The second time was about 14 years later, and it involved a little 60ish year old lady with MS who we had ventilated with septic shock and ARDS for about 4 weeks. She also went into v-fib arrest, this time witnessed, so CPR began immediately. When CPR was ongoing, she pushed us away. Repeatedly. We were never able to achieve ROSC. After a prolonged arrest, and after using every tool at our disposal, I finally had to call the code. In this case, I swear she was looking at me while awake and telling me "no". That part could be in my imagination. Nevertheless, she was awake enough during the arrest. That was 28 years ago and obviously also has stuck with me.
Anyone else have similar experiences? I just wonder if we all have.
See the link in the comments. Freaking wild.
Lots of time during good CPR my patients start to make grimaces.
Because of that I give a little bit of sufentanil and midazolam during all my CPR's.
Topic is fascinating.
Thanks to a my google storage account on November 18, 2019
went to: What Happens When We Die?: Surviving Cardiac Arrest at the New York Academy of Sciences.
Google does not have a link but chatgpt was able to find the link to its program!
https://www.youtube.com/watch?v=gpfriTZDWCY.
At right near 46:19 is a story that have not forgotten. WORTH IT. The doctor tells it beautifully, but it's sort of haunting -- basically the patient undergoing arrest is able to ascertain the inner thoughts of the intern performing the cpr!
It's not the best audio but listen if you'd like it's a great conversation from experts in this space.
To give you a flavor of the “researcher vibes” - haha.
I recall I was a first-year res rotating on a medical service when we had a Code Blue in the wee hours. The patient was extremely large and not that old. As the upper-level trainees filtered in the room, the groans and comments began. "aw, man! She's a friggen"whale! Just push her back in the water! Don't cover thw blow hole"1 Etc. Etc. I felt embarrased by the banter and kept my moth shut. She was still someone's mom, sister, wife, grandmother, etc., we wouldn't do that if they were in the room. The patient opened her eyes briefly and said "You're all laughung at me because I'm so fat!" then colsed her eyes and expired. We all felt like total shmucks.
That's really unfortunate. Glad you didn't partake.