tough call

we get difficult calls sometime that we were forced to face.
calls which is difficult for us and for the patient's relatives.

there was this one particular time of the day, where this patient suddenly desaturated, and then collapsed.
we attempted intubation and infused inotropes to keep the heart beating and keep the blood flow good.

That patient, lasted through the day.. but when night came by, fate turned around.

His peripheries suddenly became cold and blue, he desaturated even on high oxygen flow.
His heart slowed, his pressure went haywire and we attempted CPR and maximised the inotropes.

After 20minutes of CPR, he did not revived but his heart showed electrical activity. His eyes were fully dilated.

He had pulse which were very very feeble , that some of us thought it was just our imagination as it was too difficult to palpate.

We continued CPR for another 20minutes, and one of us stopped the inotropes.

Formally, CPR is commenced for 20 minutes before we confirmed death.

After another 20minutes CPR, he did not revived and electrical activity to the heart started faded and later, went flat lined.

Question is, are we at fault for stopping the inotropes? in most cases, they never revived after 20minutes of CPR even on maximised inotropes.

In my view, we are not wrong. We could just let inotropes run and stop CPR, and the heart will eventually stop too. Eyes were dilated is already a sign of brain death. A brain death is as good as death. And it is normal for a heart to show some activity after a person already dead because organ died at different time. and by continuing inotropes, will just make the process longer.

tough call huh?