Cardiac arrest. Old frail man in his 80’s in a hospital bed. Wife was talking to him, and then after awhile noticed he had stopped talking back, not that he ever said much in the first place. We put him down on the floor. He was warm and limber, but asystole in three leads. I intubated him while an officer did CPR. The initial ETCO2 was 40, which encouraged me that we could save him, but it steadily plummeted down to 5.
I looked at the officer doing CPR and was surprised to see his hand was off center and he wasn’t doing very good compressions. “Get right on the sternum,” I said. “Hard, fast and deep.” I wanted to get the ETCO2 number back up in a decent range. The better the CPR, the higher the ETCO2. It stayed at 5. He was barely pushing at all.
“No, like this,” I said.
I put my hand on the sternum and pushed hard.
With that awful crunching sound, my hand seemed to go break right through the man’s chest. It was like the sternum broke completely off from all the ribs and sank right down on top of his heart.
The officer looked at me with a knowing sadness.
My bad, I said silently.
Working at my other job as clinical coordinator at a local hospital, I have been tracking prehospital cardiac arrests and cardiac arrest saves. The saves, like the literature says, are almost all witnessed arrests with a presenting rhythm of vfib, who get early CPR and early defib. And the patients are almost all in the 50s and 60s. 80-year-olds in asystole with unknown down time do not come back. Sure you might get a pulse and a pressure for awhile, but they don’t open their eyes and see the world again. They don’t walk out of the hospital and back to the arms of their loved ones.
And for all the emphasis on the new CPR, pushing hard, fast and deep, some of these frail old bodies, you just can’t do CPR on. There is no bend in their bodies, only break, as with pressure, their bones turn to dust.
We finished out our twenty minutes with no change in the flatline and the ETCO2 registering only 3. I called the hospital and got permission to cease. Before we stopped, I had the family members gather around and say their goodbyes. He was an old man who had been sick and had been expected to die, but he was greatly loved by his wife and daughters and grandchildren and great grandchildren. We took out the ET tube and removed the IV and peeled off the electrodes and defib patch, and picked his old body up off the floor and set him back into bed. We covered him with a sheet up to his neck, and closed his eyelids, and gently lifted his head to place a pillow underneath it.