CPR Induced Consciousness

April 10, 2017

Short Attention Span Summary

Dude, get off my chest!
Ask any paramedic – they’ve probably seen this.  Sometimes, CPR is so good that patients have flickers of consciousness, which can catch you off guard.  This Australian study found that it occurs about 1% of the time and appears to be a favorable sign.  The most common manifestations of consciousness were: “spontaneous eye opening (20.5%), jaw tone (20.5%), speech (29.5%) and/or body movement (87.5%).”  Odds of survival was better in those who did not get sedative medications, but evidence is too sparse to make firm recommendations.

Spoon Feed
Some manifestation of CPR-induced consciousness occurs about 1% of the time and should not alter the resuscitation efforts.  Obviously, you may want to check for a pulse.

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Abstract

Resuscitation. 2017 Feb 1;113:44-50. doi: 10.1016/j.resuscitation.2017.01.018. [Epub ahead of print]

Consciousness induced during cardiopulmonary resuscitation: An observational study.

Olaussen A1, Nehme Z2, Shepherd M3, Jennings PA4, Bernard S5, Mitra B6, Smith K7.

Author information:

1Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia; Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.

2Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia; Department of Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Emergency Operations, Ambulance Victoria, Doncaster, Victoria, Australia. Electronic address: ziad.nehme@ambulance.vic.gov.au.

3Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia; Department of Emergency Operations, Ambulance Victoria, Doncaster, Victoria, Australia.

4Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia; Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Emergency Operations, Ambulance Victoria, Doncaster, Victoria, Australia; College of Health and Biomedicine, Victoria University, Melbourne, Victoria, Australia.

5Department of Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

6Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

7Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia; Department of Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, Western Australia, Australia.

Abstract

BACKGROUND:

Cardiopulmonary resuscitation-induced consciousness (CPRIC) is a phenomenon that has been described in only a handful of case reports. In this study, we aimed to describe CPRIC in out-of-hospital cardiac arrest (OHCA) patients and determine its association with survival outcomes.

METHODS:

Retrospective study of registry-based data from Victoria, Australia between January 2008 and December 2014. Adult OHCA patients treated by emergency medical services (EMS) were included. Multivariable logistic regression was used to determine the association between CPRIC and survival to hospital discharge.

RESULTS:

There were 112 (0.7%) cases of CPRIC among 16,558 EMS attempted resuscitations, increasing in frequency from 0.3% in 2008 to 0.9% in 2014 (p=0.004). Levels of consciousness consisted of spontaneous eye opening (20.5%), jaw tone (20.5%), speech (29.5%) and/or body movement (87.5%). CPRIC was independently associated with an increased odds of survival to hospital discharge in unwitnessed/bystander witnessed events (OR 2.09, 95% CI: 1.14, 3.81; p=0.02) but not in EMS witnessed events (OR 0.98, 95% CI: 0.49, 1.96; p=0.96). Forty-two (37.5%) patients with CPRIC received treatment with one or more of midazolam (35.7%), opiates (5.4%) or muscle relaxants (3.6%). When stratified by use of these medications, CPRIC in unwitnessed/bystander witnessed patients was associated with improved odds of survival to hospital discharge if medications were not given (OR 3.92, 95% CI: 1.66, 9.28; p=0.002), but did not influence survival if these medications were given (OR 0.97, 95% CI: 0.37, 2.57; p=0.97).

CONCLUSION:

Although CPRIC is uncommon, its occurrence is increasing and may be associated with improved outcomes. The appropriate management of CPRIC requires further evaluation.

Copyright © 2017 Elsevier B.V. All rights reserved.

PMID: 28161214 [PubMed – as supplied by publisher]