A few friends were with me, all nurses, and we recalled some of the CPR events we have been involved in. A pivotal point to consider by all Nurses, Physicians, and Respiratory Therapists is that a patient may die even if the team did everything correctly. An underlying condition such as left outflow tract stenosis or blockage translates into limited to no effect when CPR is provided–optimal management aside, many sources reported up to 2019 a range of percentages of individuals making it through a CPR event, but generally 10% of the survivors made it to discharge, the status of functionality unknown. Every minute counts when there is a respiratory arrest leading to a cardiac arrest; the team has precious little time to keep significant damage to the heart, brain, and other body systems from occurring.

Each year an estimated 40,000 Canadians have a cardiac arrest, key factors; a bystander initiates CPR and assigns others to call 911; more vulnerable groups are women, Indigenous people, those who live in high rises, rural settings, and the uncertainty if someone has an Advanced Care Directive or no CPR qualifier regarding their health status. The need for people to discuss with loved ones, friends, spouses, etc., is not easy, as a deep dive into dying is not comfortable for many.

There is a strange irony when a patient arrives from a long-term care facility, frail and has contractures, altered cognitive status, unable to swallow, receives gastrostomy feeds and the transfer documents show full resuscitation status. There can be many reasons a family cannot acknowledge a need to reassess their loved ones’ code status; it may be guilt, finances, fear, and for some not understanding it’s not about their choice but what their parent, spouse, sibling, child, or friend would want.

The act of CPR and, concurrently, the increased access to external defibrillators is helping many. However, it’s recognized more public locations need AEDs (Automated External Defibrillators), such as hotels, condo high rises, all shopping malls, etc. Even apps that would alert engaged public members in a geographical area an AED/CPR are needed. Without intervention, 0-4 minutes is none to minimal damage; in 5-7 minutes, the heart and brain are compromised due to low oxygen levels, and over 7 minutes, permanent changes and very possibly death are the likely outcomes.

More upstream approaches could include: those identified at risk for a sudden unexpected cardiac event be transferred to a tertiary centre as early as indicated, working on understanding sudden unexpected cardiac arrests and how to prevent them; a strategic aim of the Heart & Stroke Foundation is to build a network of cardiac arrest survivors to explore the implications of neurological and emotional problems that arise so policy and advocacy strategies can be informed by these survivors.

As professionals, we run to rescue patients notwithstanding the need to don Personal Protection Equipment; watching the team, there is a rhythm to the code, safety checks built in, role clarity, and the sequence of compressions and smooth transitions among staff to sustain the effort. The relief when a patient returns and the palpable sadness when death is declared. It is a source of stress and loss, and there for the grace of God, any of us could be in that spot.

Everyone, please talk to the significant people in your life and make your choices known, how much, how far, explore palliative care, and ensure your life has quality, not only quantity. Live the dash between birth and death; so much to see and do and experience. Namaste.

Categories: Uncategorized

Paula M

Registered Nurse Storyteller, Healer, Scribe, Transformational Leader