When I saw the patient die, I knew that CPR was much more difficult than I thought

As a doctor of medicine and a registered nurse working at an Australian hospital, I can't remember how many deaths I have seen in the hospital. Participate in a rescue in person and watch the patient's life die. The feeling of loneliness pushed to the line of life and death is unforgettable.

The emergency room I used to work in

Life and death often come at a critical moment. Cardiopulmonary Resuscitation (CPR) and a series of advanced life support are the last weapons for medical staff and death. But unlike what you can see from the TV series, the cardiopulmonary resuscitation in clinical rescue is really not so magical, it is more cruel and helpless.

Cardiopulmonary resuscitation is a first-aid measure to help patients with cardiac arrest. Artificial brain function is maintained until natural breathing and blood circulation are restored.

                              Instant death

One evening during my undergraduate apprenticeship, when the Code Blue alert sounded in my ears for the first time, my mind was blank, and the stunned moment saw my colleagues around flying towards the rescue room. Code Blue is a hospital code that indicates that a cardiopulmonary resuscitation team is required to go to the clinic, which means that the patient is likely to have a heartbeat that is about to or has already occurred. I took a deep breath and walked quickly to the rescue room.

Code Blue, the code that calls for life

It was a native native man with a wide body and a fat body. When he arrived, the on-site emergency staff was still kneeling on the bed for CPR. The 30-square-meter independent rescue room was instantly crowded with people. The monitor and the ventilator made a harsh tweet. For a moment, I could feel my heartbeat start to accelerate.

A strong male nurse took the chore of chest compressions, which is the basic to ensure the patient's internal circulation. At the same time, the anesthesiologist has connected the tracheal intubation to the ventilator to prolong the life of oxygen supply to the body cells. The nurses have already connected the monitors and opened two venous channels (the indwelling needle can be used to quickly inject drugs when needed). Cardiopulmonary resuscitation is the drumbeat that makes a mess orderly.

Cardiopulmonary resuscitation has been in progress for more than 30 minutes after emergency personnel gave a brief description of on-site first aid. The man on the bed was naked and the fat was shaking around the rhythm of the press. The tube of the drug was injected but it still didn't work. The surgeon who came to the clinic at this time struck over the meteor, and he wore a magnifying lens light that had not been able to turn it off. He saw it just coming down from the operating table. He silently shook his head three times and hurried away after talking to the director.

The nurses and doctors performing chest compressions have changed for several rounds, and everyone is sweating and panting. At this time, the director said, "Get on to lucas (automatic cardiopulmonary press)." I was already on the side, quickly carried lucas to the bedside, and set up the machine with the help of the nurse. Watching the robotic arm press on the man's chest rhythmically, life seemed to flow away with the ticking sound of the monitor.

Manual compression has the characteristics of flexibility and maneuverability, but if there is a shortage of ambulance personnel and fatigue, an automatic cardiopulmonary press is more advantageous.

Cardiopulmonary resuscitation can last a long time, from tens of minutes to several hours. Do not stop until it is effective, or there is sufficient evidence that it will never be effective. Nearly an hour after the rescue of CPR, the director finally asked, "Do you have any suggestions or ideas?" Everyone was silent. "Death time 19:28, thank you all."

Unlike the happy ending in the TV series, this game still won. The end of the rescue may be a bit abrupt and cruel. After the director's announcement, the doctors and nurses leave quietly and quickly. The tubes and needles that remain in the patient's body will remain intact for the time being, because sudden death may require autopsy, and these rescue measures need to be reviewed by legal procedures. Before I stepped out of the rescue room, I finally glanced at him and covered his naked body with white sheets. As if nothing had happened before, he just fell asleep so quietly.

                             Misunderstood CPR

Cardiopulmonary resuscitation in TV series | American drama "Grey's Anatomy"

But unlike the performance in the TV series, in reality, for most people who receive CPR, this is the last experience in their lives, just like the unfortunate indigenous people. Clinical practice has found that 45% of patients with a cardiopulmonary resuscitation duration of less than 5 minutes can eventually be discharged, and when the resuscitation duration lasts more than 20 minutes, this rate will drop sharply to less than 5%.

In my limited experience, most patients receiving CPR in hospitals have not been successful. Only one patient in the intensive care unit was successfully rescued, and breathing and heartbeat were restored. And three days later, he also died of irreversible brain damage.

Many patients in film and television works not only survived after CPR, but even left the emergency room intact. But in reality, we are more facing the mess after the rescue. With chest compressions, the patient's ribs may fracture and the body may become bruised. A study of the Minnesota Hospital in the United States showed that 13% of patients receiving cardiopulmonary resuscitation between 2009 and 2012 were injured as a result of resuscitation, 9% of patients had rib fractures, and 3% had lung injuries. At the critical moment when blood flow stops, the patient's brain cells and various organs begin to fail. According to statistics, in the US hospital from 2000 to 2009, of the 12,500 patients who survived CPR, more than 5% had moderate brain damage and could not take care of themselves. There are also more than 1% of people in a chronic or permanent coma.

Cardiopulmonary resuscitation can cause organ damage and fractures

Even though it is possible to face all kinds of helplessness, in the medical community, cardiopulmonary resuscitation is still solemn and sacred. "Even if the probability is useless, we have to try it at least", this is what most doctors think about CPR. Because as long as people have a last breath, it means that they also have a connection with their lover, with tradition, with nature, and with customs. Not letting this connection break easily is the biggest conviction of healthcare workers.

I used to think that rescue is a cruel and long process, but from the moment I saw death, I also understood one thing, even if the hope is slim, as long as it can save one's life, all our efforts is worth it.