An exploration of UK paramedics’ experiences of cardiopulmonary resuscitation-induced consciousness

Abstract

<sec id="s1"> Introduction: Consciousness may occur during cardiopulmonary resuscitation despite the absence of a palpable pulse. This phenomenon, known as CPR-Induced Consciousness (CPR-IC), was first described over three decades ago and there has been an increase in case reports describing it. However, there remains limited evidence in relation to the incidence of CPR-IC and to practitioners’ experiences of it. </sec> <sec id="s2"> Methods: A mixed-methods, cross-sectional survey of paramedics who were registered with the Health and Care Professions Council (HCPC) and working in the United Kingdom (UK) at the time of the survey. Participants who had experienced CPR-IC were asked to provide details about the number of episodes, a description of how consciousness was manifested and whether or not it interfered with resuscitation. </sec> <sec id="s3"> Results: 293 eligible participants completed the study and 167 (57%) said that they had witnessed CPR-IC. Of those, over 56% reported that they had experienced it on at least two occasions. CPR-IC was deemed to interfere with resuscitation in nearly 50% of first experiences but this fell to around 31% by the third experience. The most common reasons for CPR-IC to interfere with resuscitation were: patient resisting clinical interventions, increased rhythm and pulse checks, distress, confusion and reluctance to perform CPR. </sec> <sec id="s4"> Conclusions: The prevalence of CPR-IC in our study was similar to that in earlier studies; however, unlike the other studies, we did not define what constituted interfering CPR-IC. Our findings suggest that interference may be related as much to the exposure of the clinician to CPR-IC as to any specific characteristic of the phenomenon itself. </sec>

Pre-hospital guidelines for CPR-Induced Consciousness (CPRIC): A scoping review

“… 3 , 4 CPRIC presentations cause significant impedance of vital lifesaving management in cardiac arrest. 36 , 37 This is especially pertinent in that CPRIC presents more commonly in the most viable of patients. Patients who will benefit most from CPRIC treatment algorithms have the highest chances of survival.…”

“…Lack of consensus guidelines could indicate a large cohort of these patients are going untreated, decreasing their own survival rates. 37 Contrary to this issue are patients receiving treatment and the potential negative effects this can have on overall outcomes. The lack of consensus guidelines has directly produced significantly varied prehospital CPRIC guidelines, the majority of which treat with Midazolam.…”

“…CPRIC is increasing in occurrence. 1 , 3 , 37 Prehospital systems around the world continue to strive for more efficient ways to manage cardiac arrest. This results in higher quality CPR, improved prehospital services and earlier implementation of the chain of survival.…”

CPR-related cognitive activity, consciousness, awareness and recall, and its management: A scoping review

“… 45% used midazolam, 11% ketamine, 4% opioids All worried medication may have negative impact circulation and felt there was a lack of evidence on dose-effects relationship. NA Gregory 2020 15 Cross-sectional study Survey distributed to paramedics registered in the UK 293 registered paramedics Reports of rescuer witnessed CPR-induced consciousness/ Nature of CPR-induced consciousness. Whether and how CPR-induced consciousness interfered with CPR.…”

Development of an international prehospital CPR-induced consciousness guideline: A Delphi study

“…4,14 Improved prehospital systems and CPR advancements will result in increased rates of CPR-Induced Consciousness presentations. 1,15 In the absence of clinical guidelines, prehospital services with more frequent presentations of CPR-Induced Consciousness will develop different treatment protocols resulting in even more varied methods of treatment, making it even harder to collate outcome data and evaluate evidence-based guidelines. 12 A consensus guideline would be expected to benefit paramedics and other prehospital clinicians.…”