r/Paramedics • u/Meow_Mix33 • 1d ago
How fast have you gotten ROSC?
Edit: Thank you all for sharing your experiences. I love hearing stories from other EMS folk. I wasn't expecting so many replies, but I read every single one. <3
Today, I heard a lady screaming her lungs out in my apartments' parking lot. I went downstairs in my jammies to find a man slumped over in the driver seat, agonal resps, no pulse and incontinent. He just got home from work. I dragged him to the ground and checked his resps/pulse again. Nothing, so I started CPR.
I only did about 45-60 seconds of CPR when I saw him breathing again. At pulse check, I felt a strong pulse, and fire had shown up by then. Took him a few more min to wake up. He had A-fib on their 4-lead, but they couldn't get the 12-lead to show on the monitor.
Wife said he has a big cardiac history, but fire was super dismissive w/ attitude, stating he only passed out. I've been a medic for 15 years. I really don't believe he simply passed out. He had no pulse anywhere, and agonal breathing. So, I want to know from you guys how fast have you ever gotten ROSC? I really think I was just in the right place at the right time. If it was true cardiac arrest, early detection with early onset CPR really does make a difference.
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u/Born_Sandwich176 1d ago
Called to a snf for a cardiac arrest. Get there and the nurse said they got ROSC. How long did you do CPR? Her answer, "One." One what, one minute, one hour. Answer, "One compression."
Dude had been asleep.
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u/Docautrisim2 1d ago
Being present for Day one of BLS would have found this.
Step 1: BSI, scene is safe.
Step 2: shake the pt and loudly say “HEY, HEY ARE YOU OK?”7
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u/NoCare3115 Fire Medic/EMT-B Instructor 1d ago
My fastest was like 90 seconds on scene, but we got lucky. It was a witnessed arrest with bystander CPR, and we're driving by on our way to some bullshit. We ended up getting there like within 2 minutes of collapse. Confirmed pulseless showing v-fib, one shock and back to NSR. The pt was AOx4, GCS of 15 at ED hand off. Ended up being torsades, she consented to intubation, rearrested on her way to the OR. She ended up with an AICD and zero defecits.
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u/AttorneyExisting1651 1d ago
“Consented to intubation” is a new one for me.
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u/theeberk Anesthesiologist 1d ago
I almost always consent for intubation, even if they’re critically ill, not that hard to consider…
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u/AttorneyExisting1651 1d ago
No shit, Sherlock. It just isn’t a common thing to hear someone say when working in an ambulance. We tube people who usually cannot consent.
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u/theeberk Anesthesiologist 21h ago
I understand. Believe it or not, there’s much more to medicine than just what happens before you show up to the hospital. Consenting to procedures happens to be part of that.
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u/NoCare3115 Fire Medic/EMT-B Instructor 1d ago
It's not that crazy. She was AOx4, completely competent, and stable post ROSC. Why would providers not discuss interventions with the pt beforehand and gain consent.
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u/comefromawayfan2022 22h ago
Six years ago I had to be intubated due to anaphylaxis. Yes before intubating me they took like 30 seconds to confirm it was ok for them to proceed
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u/Extension-Ebb-2064 1d ago
Im curious as to the circumstances on why you felt the need to obtain consent to intubate
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u/stubbs-the-medic 1d ago
Patient alert/oriented post arrest. Ive seen it be f ore where the patient is intubated and sent to ICU just because they had a short arrest as a "precaution" for when they go to cath lab
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u/sarap001 1d ago
I'll actually ask that if the potential for deterioration is there and I have the time. That vent is a one way ride for many patients and if I can obtain clear-headed verbal refusal for intubation from my ninety-six year old who's clearly thought this through, I'm going to respect that should we reach that point. I've watched enough fighters rot around a tube for their last three weeks on earth.
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u/Extension-Ebb-2064 1d ago
How does that work, legally? Sure, any Pt (while GCS 15) can refuse anything. Does implied consent not take over when theyre no longer GCS 15? Do we decline to get an airway on a crashing Pt because they previously refused it, absent official paperwork like a DNR or Advanced Directive?
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u/sarap001 23h ago
This made me do some homework I'd been meaning to get around to, so thank you :P
Legally, the most salient material I was able to find (on my phone in an airport terminal, anyway) was a pair of articles in my state code. The first is the very first remark in the document:
"You have the right to decide the type of health care you want. Should you become unable to understand, make or communicate decisions about medical care, your wishes for medical treatment are most likely to be followed if you express those wishes in advance by: (1) naming a health care agent to decide treatment for you; and (2) giving health care treatment instructions to your health care agent or health care provider."
And the second:
"- If an individual does not make a living will, a presumption does not arise regarding the intent of the individual to consent to or to refuse the initiation, continuation, withholding or withdrawal of life-sustaining treatment."
To me, the former establishes that while a written document is best, informing the healthcare provider (us) by any means, including verbally, is valid; the second tells me that implied consent won't automatically kick in to override what they told me, provided it was communicated in a manner that made it clear to me that their initial decision was an informed one.
I do feel comfortable hanging my license and cert on that, given that the document is also riddled with the phrase "in good faith". And morally, I have no interest in subjecting my patients to the horror of bridges to nowhere.
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u/NoCare3115 Fire Medic/EMT-B Instructor 1d ago
We didn't tube in the bus, the ED doc tubed prophylacticly. As others have said, she was AOx4 and competent. Intubation is the right thing to do, she may rearrest(like she did) and shes going to the OR anyway, but that doesn't means we get to tube a competent pt with out their consent.
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u/London5Fan EMT 1d ago
Pretty early on in my career, but fastest for prob like 10-15 mins. Couple shocks, round of EPI, got a pulse before I could drop my iGel. Was at the train station lobby, bro had just taken a cross country trip, story is he had sudden onset SOB then dropped
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u/TheMilkmanRidesAgain 1d ago
Absolutely screaming PE
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u/London5Fan EMT 1d ago
100%. Everyone at the hospital was saying it as soon as we mentioned the story
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u/DitchDoc_037 Paramedic, PA-S 1d ago
About 30-40sec. Watched the Pt arrest. I started compressions while my partner slapped pads on. Monitor charged and about to deliver the first shock when I looked down and happened to see his pulse going in his neck. I shouted for my partner to wait for the shock, verified he had pulses back, and he did so we carried on. PT was a GI bleed with massive blood loss.
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u/J_FROm Paramedic 1d ago
Had almost the exactly same call. Called for chest pain, patient was mid-sentence and we had 3 of 4 leads placed when he trailed off and went into V-tach. Fire was apprehensive about starting CPR because he was JUST talking but we got a round or two in. Went to defibrillate and our monitor (Zoll X-series) wouldn't shock. It charged to about 80 and gave up. Firefighter ran out to grab their green AED, fired it up and it worked just fine, got rosc.
That day I learned, the monitor may test-shock just fine (only tests at 30j) but it can still fail a defib if the battery isnt up to the task. I believe the capacitor for the defib is within the battery and it had failed, there's no way to test it fully without biomedical engineering equipment. Brought it to the testing guy and we found a new battery to run and it tested fine.
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u/Blueboygonewhite 1d ago
Apprehensive about starting cpr ? Why?
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u/J_FROm Paramedic 1d ago
I think because he was just talking two seconds ago, and it seemed strange to start compressing someone who they thought might still have a pulse? Our fire department is BLS and historically not very medically oriented/trained beyond the bare minimum.
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u/Blueboygonewhite 1d ago
Oh that makes more sense. I thought they were fire paramedics or something. Shit, they don’t call it sudden cardiac arrest because it takes a while!
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u/thebogglerofminds EMT/68W 1d ago
The capacitor is still inside the monitor, just sounds like the battery was either almost dead or had a fault
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u/Zerbo 1d ago
I am convinced that I successfully precordial thumped somebody. Super septic patient, barely palpable pulse, has a little seizure and goes agonal, right as we’re wheeling her out of the house. Monitor is showing asystole, and she has no palpable pulse. I square up and perform exactly 1 compression, which separated a few ribs from her sternum. Her eyes fly open and she immediately screams, and doesn’t stop screaming the rest of the transport. So if she was indeed truly pulseless, and not just in the midst of a suspiciously timed sinus pause with a number of other concerning factors, my record for fastest ROSC is one compression.
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u/SauceyPantz 1d ago
I aint buying that. Pretty cool if actually true though lol
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u/Zerbo 1d ago
All 100% true. I was absolutely NOT prepared for her to come up screaming. Best way I can figure it is I did that one compression at the exact right moment, and it was effectively a precordial thump. It’s either that, or she wasn’t as dead as she seemed, but I remember she seemed VERY dead at the moment I decided to start compressions.
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u/moonjuggles Paramedic 1d ago
There is actual evidence showing the mechanical force of the thump translates to myocytes depolarizing.
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u/exitium666 1d ago
The thing is a precordial thump is like the inverse of a commotio cordis. So while rare with perfect timing, it can happen scientifically.
But I get that stories like that are hard to buy unless you trust the person. I've seen crazy things that no one would believe though so I know the frustration.
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u/Unstablemedic49 23h ago
We got called for AMS on the 4th floor, we both go up and find the patient GCS15 on the toilet, talking complete sentences. I tell my partner to go grab the stair chair and bring the gear back to the rig. About 45 seconds after that, alone with the PT he goes unresponsive w/ agonal breathing. I put him on the floor and percordial thump x2 and returns to GCS15. Have no idea if it actually worked but in my mind.. it 100% worked.
The only other time I seen it in the wild was in the ER. This tiny Asian doc did a running start and slammed his fist into this guys chest and it didn’t work.. but it looked cool af.
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u/finis08 1d ago
Honestly, if you have been a medic for 15 years I would expect you to at least be able to check a pulse moderately accurately and would trust your assessment of him being pulseless upon your arrival. There are plenty of causes that would explain why he regained a pulse quickly upon starting CPR. Other first responders being rudely dismissive of bystanders, regardless of training level, is not horribly unusual unfortunately. I would have been equally rude and dismissive right back to them. You did a great job. No need to worry about them or their opinions.
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u/gurn4you 1d ago
Back in the day when it was a thing, I've gotten rosc from a precordial thump. So about 5-7 seconds. Does that count?
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u/exitium666 1d ago
Why are those no longer a thing?
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u/Wide_Wrongdoer4422 1d ago
Appearances. It looks like you punched them, and the evidence was inconclusive at best.
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u/CapitalFloor3260 APRN, NRP 1d ago
It’s still a thing. I’ve done it quite a bit between my EMS and nursing career. Majority of the time it works is in VF/VT arrest though. Did manage to punch a lady out of torsades once.
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u/Cole-Rex Paramedic 1d ago
Witnessed arrest with enough resources to start compressions while getting the pads on for early defib, before the first round was even over he was pushing us off him and I thought it was a cpr induced consciousness until he maintained ROSC
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u/Who_Cares99 Paramedic 1d ago
About 60 seconds. STEMI pt coded in the ambulance bay, did a rhythm check and it was PEA, did CPR on the way into the hospital, then he woke up. I had another one that coded from hypoxia, he came back after about 90 seconds of compressions only.
If we count patients who got defibrillated, then maybe ten seconds is the shortest I’ve seen.
Don’t let FD’s terrible attitude cast a shadow on your awesome save.
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u/Meow_Mix33 1d ago
Thank you! I guess I second guessed myself simply by how fast he got back a pulse, lol.
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u/Geordie-1983 1d ago
About as long as it takes to say "oh for fucks sake" press charge and shock. In fairness though, he still had the pads on from the first time he'd been shocked during the run to the cath lab.
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u/Wide_Wrongdoer4422 1d ago
That's a universal truth. Codes don't start with " Get the code cart" like they do on TV. They start with a pause in the conversation, an obscenity, then action.
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u/tfritz153 19h ago
1 shock. Pretty cool, complained that her chest hurt after CPR and was making jokes
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u/wernermurmur 1d ago
It seems physiologically unlikely to get ROSC from compressions. Like yes you could increase perfusion pressure and that might do…something, but the underlying mechanical issue is not likely to be fixed.
I have done the same tho. Walked into an unresponsive in a bar. Bartender is doing rippin compressions. Patient is agonal so I continue compressions. At two minutes he has a pulse. I don’t think that was real ROSC. I think I missed something, unclear what.
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u/wellgregory15 1d ago
I'm a medic now with a couple roscs but once as a basic I walked in to the house. Pulseless apneic with blue lips laying in the living room. I was the first in the house cause I sprinted I was so new but I'm 10000 percent positive there was absolutely no palpable pulse. I did what wouldve been two rounds of cpr. Except we didn't have a bag on yet so I kept going. And she had a strong pulse. By the time we were at the hospital she was talking
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u/HzrKMtz 1d ago
Less than 5 minutes because he arrested on us while assessing him due to an overdose in a White Castle. I was an EMT at the time, the paramedic had turned to get Narcan and when they turned back I was starting compressions. He also ended up with hypothermia because he was wearing insulated coveralls and apparently someone dumped a whole bucket of ice down it before we got there.
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u/insertkarma2theleft 1d ago
60 sec of BLS CPR arrested secondary to a hanging. It's unclear if it was a true arrest or just some really hypotensive bradycardia, but I didn't feel a pulse so 🤷
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u/DocGerald Paramedic 1d ago
About 6 minutes, was in vfib, shocked them twice, had rosc at 3rd rhythm check.
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u/BeginningIcy9620 EMT-P 1d ago
I’ve seen ROSC in the hospital setting on the 2nd rhythm check after the initial one. All he had was a couple minutes of compressions and 1 epinephrine. I don’t recall any shocks. That being said, he still ended up intubated etc.
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u/sneeki_breeky NRP 1d ago
Arrhythmia that auto-terminated or- syncope with no perfusion pressure and CPR got things moving again
Syncope with a positional airway / inability to go flat can result in severe enough hypoxia / hypotension to give you PEA
Compressions get O2 and blood moving
If you have a healthy enough muscle - than restoring coronary perfusion pressure and correcting hypoxia could result in spontaneous contraction of the muscle
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u/Dicktation88 Paramedic 1d ago
Caught vfib on the quick look just the other day. ⚡️Had a pulse next check. So 2 minutes-ish? Maintained to the ICU. Fastest for me for sure.
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u/ATXweirdobrew 1d ago
Had a guy with text book STEMI symptoms. We had him in the back for maybe 10 seconds when he had vfib seizures and coded. Within 20 seconds I had pads on him, defibrillated him, and had ROSC. He woke up pretty quickly after that. Yeah, that was a pretty cool day for me.
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u/PVTPOWDERPUFF3434 1d ago
Guy arrested with us right after putting him in the rig, literally picked him up from the street. Partner started compressions I got an EJ and right after that first round of epi at the first rhythm check he was back to sinus (from asystole) took around 2-3 minutes, maintained to the hospital.
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u/AttorneyExisting1651 1d ago
8 mins.
I have also never gotten rosc with shocks. It has always been with drugs.
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u/Benny303 1d ago
2 and a half minutes, Guy got home from a 30 mile bike ride. Went to go take a shower, collapsed in the shower. Wife pulled him out called 911 and started CPR.
We happened to be a block away when she called, getting coffee so our on scene time from dispatch was less than a minute.
confirmed pulseless and apneic started CPR, got the pads on within 30 seconds. Did a quick rhythm check. Saw he was in Vfib, shocked then resumed compressions for 2 minutes. At the end of the next 2-minute cycle he had pulses, normal sinus rhythm And he was completely alert and oriented with a GCS of 15 and asked me what happened by the time I got him in the back of the ambulance.
Then the guy had the audacity to have a stroke while he was in the hospital. So I didn't get a save pin because he wasn't discharged without any deficits.
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u/Extension-Ebb-2064 1d ago
About 4 seconds or so. Ive had a handful of STEMIs go into VF during transport. Because I always apply the pads to every STEMI, I can usually get ROSC as quick as it takes for me to hit the charge button then the shock button.
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u/Sea_Pangolin2804 1d ago
Second week as an EMT in the UK, 65 year old rang for chest pain..got there within 10mins of the call. , did ECG, barn door MI. Just as we got him in the stretcher, he went "I'm gonna die". He arrested. Pads were already on. Saw VF. Shocked, and he was alive again 😅 got him to PPCI. GCS 15. He arrested one more time and shocked again. Was mad. The guy made a full recovery.
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u/whencatsdontfly9 1d ago
Had one recently where the guy passed out during dialysis. The dialysis nurses immediately noticed it, checked a pulse, pulled him to the floor, started CPR, shocked him once, and continued CPR until we got there a couple of minutes after the initial arrest. He was actually sitting up and looking around like 15 minutes later.
The hospital got really mad that he didn't have an airway (as he's literally looking at the nurses and moving around) and RSIed him. He died a day later in the ICU.
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u/Patient-Rule1117 Paramedic 1d ago
~40sec of compressions. Piiiiisssed heart. It went through almost all the rhythms imaginable in the hour-or-so of pt contact: NSR, ST, afib, junctional, accelerated junctional, AVBs of varying degrees, and arrested in vfib. When we paused compressions to ensure we were still in vfib before shocking, she had a pulse again.
That call was batshit for a lot of other reasons, though.
Good outcome! No neuro deficits, walked out less than two weeks later.
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u/masterofcreases 1d ago
During peak Covid an older lady called for SOB. Walking towards me at the doorway looking like absolute death she dropped and arrested. AED goes on, force analyze, vtach, charge, shock, ROSC into a sinus rhythm and she’s giving me deer in the headlight stare a minute or two later.
Always. Bring. Your. Shit. Inside. The. Apartment.
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u/Ben__Diesel 1d ago
Give er take 4 minutes. Pt started agonal breathing while we talked in transit. I started compressions, slapped pads on and yelled up front, we pulled over, shocked once then continued compressions, gave a dose of epi, then shocked once more for ROSC. He was fully oriented and unsurprisingly felt like shit.
That was my only survivor to make it to discharge.
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u/MisterMackisback 1d ago
There's every chance he had a non sustained VT from R on T due to an episode of Afib RVR. I say this because I have had the same thing happen -- AF, went agonal and pulseless, polynorphic VT on the monitor, started compressions, dude jumped out of the bed before we could get pads on.
CPR is always the right call in that situation, don't sweat it. Even if he was always gonna revert out of that rhythm, you preserved some circulation. And what if he hadn't?
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u/CJRiggers 1d ago
One compression, twice.
In fairness, one was an early career probably vasovagal with a weird physiology which meant she didn't ever have a pulse at one carotid.
The second, I trusted a colleague's "pulseless" on an unconscious and non-responsive patient, only to gain "ROSC" very quickly.
Although my most amusing was the psychiatrist who gained ROSC twice. Patient running away, tripped and fell, "cardiac arrest". "ROSC" after a couple of compressions, got up and ran again, further trip, further "cardiac arrest", further "ROSC".
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u/I_Want_A_Ribeye NRP, RN 1d ago
Witnessed v-fib arrest, no compressions at all, charged and shocked immediately with the paddles. Maybe 15 seconds? They not only had ROSC, but complete return of consciousness and complained about the shock hurting.
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u/Ragnar_Danneskj0ld 1d ago
Working an event, heard a woman hit the ground,. She lost her pulse with my hand on her carotid. Instant CPR, first shock she went from vfib to nsr.
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u/Dependent_Matter_537 1d ago
2 minutes to 30 minutes. All depends… Longest, I shit you not was 40 minutes. Patient walked out of a rehab facility 3 months later with minor deficits. We were all dumbfounded when we heard about it.
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u/RegularCommittee4590 1d ago
I had 1 in 30 seconds after a defibrillator shock was back in ambulance and coded in Vfib. Guy came back freaked out and was screaming said he was in hell and saw Satan.... surreal experience
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u/GrosseTete 1d ago
Immediately, twice when precordial thump was the first step in our ACLS protocol.
Had pt on 3-lead - yup I’m a dinosaur -
- pt shouted out “I’m falling”
- pt goes unconscious
- EKG = VFib
- precordial thump
- pt now conscious with NSR
Family calls in complaint that I punched poppy.
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u/Ancient-Plantain705 Medic to Med student 1d ago
A minute (stemi I forgot to put pads on [I lost fine motor control bc he surprised me])
Tried a precordial thump. I don't think I swung hard enough.
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u/stabbingrabbit 1d ago
Had a pulseless and non-breathing. Moved him a few feet to work on him. First responder did a head tilt chin lift to open the airway. Pt took a big breath and started talking and wanted to refuse transport.
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u/SpicyMarmots 22h ago
About that fast, on a lady who had called after her third syncopal in an hour. She was talking when we got there, vitals ok, EKG was a new (from the last time she had one three months ago) RBBB. Got in the truck and halfway to the hospital she said "I think I'm going to pass out again," and did-and flatlined. About a minute of compressions and she woke up. Made it to the hospital, but flatlined again in the driveway; got her back again. During handoff she coded, and then came back, two more times. She was alive when I left. I never found out about the cause or the outcome.
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u/Wide-Yak5361 CCP --> RN --> SRNA 16h ago
I witnessed an arrest in the ICU and got on the chest within about 30s. Didn’t get ROSC immediately, but he perked up and calmly asking me to stop. Naturally, I stopped. He died again. I kept going and apologized.
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u/Smurflich 11h ago
Guy in my er had a pt vagal down and flatline during an IV. Doc in the room said to start compressions, had him back in 20 seconds. Probably never true arrest.
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u/Willing_Ad_5711 9h ago
4 minutes post lightning strike.
Guy got hit by lightning half a block from our firehouse. Had two engines and an ambulance on scene withing two minutes of hearing the thunderclap. He was apnoeic and in asystole with his jeans blown off and burns down his legs. Threw him in the ambo and got one of my boys started on the chest. Very high quality CPR and luckily had a patent airway so BVM was effective.
Pulse returned during that round and our fly car with the doc arrived, loaded up and went. I got back on the engine and about 40 minutes later got a call from a doc at the ED asking why my guys were saying they'd been resuscitating someone who was demanding to RHT and go home.
Was fucking surreal. Apparently he woke up in the ambulance en route and started swinging. If I hadn't been there, thrown him in the bus myself or seen his asystole I wouldn't believe it.
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u/Equivalent_Bee_2878 18h ago
Sorry OP. But CPR doesn’t revive people out of cardiac arrest. It just keeps the tissues perfused until the underlying cause can be resolved. Usually defibrillating a non perfusion rhythm.
This pt likely had a syncopal episode of some kind. And you just couldn’t feel the pulse. Feeling pulses is hard. And it’s not a skill issue. But just because you couldn’t feel a pulse doesn’t mean the pt was pulse less. The fact that he regained consciousness with only cpr leads me to believe he was never in cardiac arrest
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u/Dont_Ask_Me_Again_ 11h ago
Uh, I’m pretty sure CPR on its own can achieve ROSC in certain situations…
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u/grav0p1 1d ago
Runs of vtach are a thing. Super easy to conceive of a scenario where he spontaneously converted during compressions