Unsuccessful CPR

[seagull20]

My DS is a beach lifeguard. Yesterday there was an emergency on the beach, they performed CPR and used the defibrillator and then assisted emergency services when they arrived. Unfortunately it wasn't successful.

He was very upset when I collected him after work. We have talked about it a lot and he seems OK, upset and shocked but understands they did best they could. His work and the emergency services have been really reassuring too. He is very upset about the person who died and their family and kept saying 'why does everyone say well done when he died.'

I've not been through anything like this and neither has DH, we both have boring office based jobs. I'm wondering how we can best support him- can this kind of experience cause PTSD or is to be expected in this kind of job? He is only 18, I don't want to keep fussing him but I want to make sure he is OK after and stays OK too. How long does it take to get back to normal after this kind of experience.

As @Koifish says, A document from NICE on the internet states:
Around 7–8% of people in whom resuscitation is attempted survive to hospital discharge.
Immediate initiation of CPR can double or quadruple survival from out hospital cardiac arrest.

Your son increased the patient’s chance of survival - but even quadrupling an 8% chance of survival is 32% (still low).

Not all causes of cardiac arrest are treatable (eg too much damage to heart muscle from heart attack) - so the patient may not have survived even if he had been in hospital with all the experts and equipment there.

I hope he can be comforted that he has done his best and gave the patient the best chance of survival. And I hope he can get counselling if he needs it.

When I did my first aid training, if you do nothing, they WILL die, if you try, there's a chance. It will mean a hell of a lot to the persons family and friends that everything possible was done to try and save him, regardless of the outcome, he should be very proud of himself for being part of the effort.

I think it's possible too that in the shock of what had happened your DS might not have taken onboard what was said if there was a debrief at the time. Or any offers of counselling. My understanding is that the ambulance service do usually do a fairly good debrief for all involved. But that doesn't mean in the shock of the moment that your DS heard any of it. It would be worth him talking with his boss or better still with the ambulance service if possible. It's worth noting that your DS's boss may never have had this happen before or only on a couple of occasions.

One thing I forgot to mention earlier, when I was supporting my colleague who had dealt with an unsuccessful CPR effort, was that there was a lot of adrenaline flying around on the day, with the physical effort and emotional stress. They did not want to go home and be alone, so stayed at work for company even though not really able to functionally work. And they were exhausted the following day as the crash happened hormonally, mentally and physical reaction to the effort all set in.

It took a few days to get back on a relatively even keel and be relatively normally functioning, and we had a number of coffees over the following few weeks to pragmatically process both the incident itself and what they felt may have been good and bad in the response to it (as a report was required on the incident itself and what happened for Health & Safety, and a separate note for HR to use for dealing with the family, and another reflection on "lessons learned" - although generally there were no lessons to be learned except that the processes in place had worked so to reiterate those).

But it did take much longer for them to stop feeling guilty and fully accept the outcome. Even though things were done right and also that the patient had not been alone at the time, and my colleagues' head was telling them they had done the right thing and given the patient every chance, knowing the stats - but their heart was still rocked for the loss of their friend and the emotions of the event. And as a seasoned adult who had dealt with a few tricky deaths in their circle before then.

Poor, poor lad. Yes do keep an eye on things and make sure he knows he has option to support him.

My dad and sibling performed (unsuccessful) CPR on my mum. They were heroic, as were the paramedics who took over but nothing could be done.

I hope in time your DS can appreciate that he did do his best and that was a Hell of a lot more than most could have done.

Your poor son - that's horrible for anyone to have to deal with but at 18 it's a sudden stark reminder of the fragility of life.

The bottom line is that CPR doesn't always work. Even if it does, it's not like the movies where people suddenly burst back to life.

If his employer doesn't have access to support (which it absolutely should, considering the potential for something like this to happen), does either your or your DH's work have an employee assistance program? Some of these are open to family members, or you could contact them with your concerns for your son.

It's been so helpful and reassuring to read everyone's posts. Yhanks for sharing your experiences and knowledge. It has been really difficult to get my head round it, my ds coping with something so challenging that I have no control or experience of. I really appreciate all the helpful suggestions and links they'll help me to support DS.

I've been involved in a fair few successful and unsuccessful CPRs (HCP). Unsuccessful outweighs by far.

I always felt awful and guilty afterwards, and questioned if there was more that I could have done. The feeling wears off with time (as most things do) and with realising that when someone is in cardiac arrest they have generally died of some kind of natural cause (even in things like a car accident - dying of severe injuries is natural).

Resuscitation is in a way fighting against a natural consequence, and there are no guarantees and little chance of getting someone back from whatever caused them to cardiac arrest in the first place, even in a hospital setting with someone found very quickly once their trouble starts.

CPR holds open a possibility, and for those who can recover it is well worth the effort and backache. For those who don't come back the effort is still worth it for that chance of survivability.

Your son participated in a good thing. Something that would make anyone feel shaky. But if he can't come to a satisfactory calm place about it then he should see a GP, or his work Occupational Therapy to ask for help.

I suspect you live near me. I read about this in the local news. I immediately thought of the lifeguards and how they must have felt - I know many are quite young and all the training can't prepare you for the real thing. I also worried about how they would feel afterwards and hoped they would get support. Your son, the other lifeguards and other services involved are heroes in my eyes.

I was going to say something similar to this.

Your son did a good thing and it was clearly traumatic for him, but it won't automatically lead to PTSD.

My younger brother died last year after unsuccessful CPR. What got me through it was the completely selfless help strangers gave him, and that he didn’t die alone. Your son is amazing.

(Paramedic)

A recent study found that there was no more psychological trauma in bystanders who partook in CPR attempts compared to those who simply witnessed a cardiac arrest/CPR (I think it was actually slightly less in the active CPR group but not enough to be statically significant).

It is important to remind your son that it would be odd and a little worrying if something like this didn't effect him and upset him. His response is normal.

In terms of PTSD, any reaction at this stage is normal, if he is still getting flash backs, nightmares and ruminating for long periods after 4-6 weeks, then that is the point to seek help.

If a public access defibrillator was used then the local ambulance service may well be happy to support him, the service I work for certainly does and will seek out the rescuer in situations like this, especially if they are young. See if you can get hold of the ambulance service and ask if support is available. It may be the lead for community first responders that can help.

Chance of CPR working is very low. By doing CPR, you aren't really doing it to save a life, it can't repair a bad heart. it's to give them a chance. Your son gave that person a chance and the family of that person doesn't have to ask "what if?" about CPR/defib. That is something.

I resuscitate people (including children) for a living and routinely run cardiac arrests. Many times we are not successful - the success rate for an out of hospital cardiac arrest is even lower. When that’s the case, all you can do is feel sure that everything that needed to be done was done, as quickly and as well as possible. That’s what people mean when they say ‘well done’ - they mean that this person got their best shot at survival because of your skill and effort.

I have also resuscitated people in the community and it is much more stressful, as I don’t have all the specialist gear and skilled team mates I have in hospital.

I see a psychologist once a month to help manage feelings from this and other aspects of my job. I’d encourage him to see someone who can talk through feelings, even as a one off, if he finds he is still having intrusive thoughts.

Can I ask where you work that this is your experience?

I would describe every one of my colleagues as exhibiting signs of post traumatic stress, and a reasonable number have experienced PTSD. I would not describe any as having ‘got over it’.

A great many health care workers do leave, reduce their hours, or retrain in a less intense area for this very reason.

There is also differing levels of trauma around a patient death - a patient you’ve known a long time or who you have a particular rapport with, a sudden or unexpected death, a death with traumatised relatives present or a death outside of our usual working environment can all trigger different feelings.

I don’t expect this young man to develop PTSD in the future but I can’t see the benefit in minimising the experience he’s had, or the support he may need. Especially as my experience of health care work in an area with high mortality has been extremely different to yours.

I expect it will take him a while to process everything that happened, adrenaline tends to take over in the moment and its not until afterwards things start to sink in. He did a very brave thing, he gave that person a chance. I think others on the thread have said most of what I would say, having carried out many resus attempts as a hcp over the years. It has always frustrated me how simple it looks on tv!

I’m sure the persons family are likely to be glad the person wasn’t alone. Having had a family member pass away totally alone, its left a lot of questions about their last moments and awful sadness no one was with them.

A great many health care workers do leave, reduce their hours, or retrain in a less intense area for this very reason.

I'm a paramedic and the majority of my colleagues, including myself (part time) who've give down this route have done so due to poor working conditions (lack of staff, late finished, long waits outside hospital), fatigue from too many years of night shifts, crap pay, bullying from management, NHS politics, or jobs so traumatic they make national headlines on several occasions (think multiple murders including children). Not due to unsuccessful CPR attempts.

My first arrest, was a witnessed arrest on the back of the ambulance (I was driving) the ambulance then promptly broke down, I'm still here nearly 2 decades later. We talked about it, the recieving doctor picked up that something untoward had happened and sat down with us whilst we completed paperwork and that was that, the patient as with most cardiac arrest was going to die whatever we did.

PTSD happens and is a terrible thing for the sufferer, but you devalue it in your post and also ignore the real reason for poor moral across the NHS.

I would agree with @EgonSpengler2020 as a doctor, I have experienced PTSD and it had nothing to do with deaths or patient care, and everything to do with how I was treated at work.

As a junior doctor I had years of being on, and then leading the cardiac arrest team. I can't say it particularly bothered me - if anything it was doing CPR on a lot of patients where it was totally inappropriate, a culture which thankfully has changed.

I hope your sons doing ok OP. He did an amazing thing. The resuscitation statistics, even with a defibrillator are scarily low. It would have been more of a surprise if it did work than it didn't although that won't necessarily help him

Oh ok. Maybe I was thinking of defibrillator stats, but that doesn't seem right either

Yes. This in spadefuls.

www.bhf.org.uk/informationsupport/support/support-if-youve-given-cpr

I found this today - it might be helpful to your ds. Sorry if someone has already mentioned it up thread.

I’ve taken part in a lot of CPR attempts as part of my job, most were ultimately unsuccessful, your first death is always hard, but I would say that not everyone is cut out for this kind of work (I don’t mean that with any disrespect, but some people just can’t handle it). I think he should talk it through with someone to gain a different perspective, but if this is still affecting him in another few weeks maybe it’s not the right job for him.

Out of hospital cardiac arrest has a very poor outcome, so this is not unusual. If it's a much older person or there are other reasons for the cardiac arrest it's not often successful. Also you have to be there within a couple of minutes doing compressions.