One of the bitter pills you must learn to swallow when you become an ER nurse is this rather ugly and depressing realization: a successful resuscitation is not the same thing as a good outcome. What I mean is this: you can restart the heart, but if the brain has been deprived of oxygen for too long, what you end up with is brain death. In other words, now you’ve restarted the heart, but there’s no one home.
When someone comes into the ER in cardiac arrest, they are wheeled in by EMS with CPR (chest compressions) in progress. The EMS responders are usually in teams of two – and one of them has to drive. Performing effective CPR is hard – very hard – for even a strong and fit individual. So that’s the first issue. The second issue is that the amount of time this individual has been “down” with no pulse is usually a rough estimate at best. That means we don’t really know how long their brain has been deprived of oxygen.
So we often end up resuscitating someone only to find out later that they were brain dead. It’s heartbreaking and disheartening when this happens, because it makes you realize that what you thought was a “successful” resuscitation wasn’t really successful at all. Unless the patient or family allows organ donation, in which case the outcome can still be positive.
I have been fortunate to have taken part in some codes that had a good outcome, and one that was actually borderline miraculous.
More on that later.
But this post is in memory if of two particular patients we resuscitated recently only to later find out they were brain dead. One was a child.
Life can be cruel. You have to focus on the greater good, act to the best of your ability with good intent, and be kind to yourself.
Tomorrow is another day.