Cardiopulmonary Resuscitation Induced Consciousness - A Case Report in an Elderly Patient

Abstract

Cardiopulmonary resuscitation-induced consciousness is a rarely described and often misunderstood phenomenon, although it can be encountered. High quality cardiopulmonary resuscitation (CPR) may lead a patient to recover consciousness while in cardiac arrest. The authors present the case of an 89-year-old male patient who received CPR after a cardiac arrest. Spontaneous movements during CPR were noted and prompted several CPR interruptions. These movements immediately stopped during chest compression pauses. Physical restraint was used in order to be able to continue with the CPR algorithm, but sedation may be the best approach. Guidelines on how to identify and manage these cases need to be developed.

2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group

“…Twenty-four case reports or series that described 31 cases of consciousness during CPR were published since 1962, with sedative drugs being used in ≈30%. 157–180 Existing drug regimens were identified that included the use of ketamine, midazolam, or fentanyl or a combination of these drugs.…”

A Rare Phenomenon of Pulseless Body Movements Induced During Prolonged Cardiopulmonary Resuscitation

“…Our resuscitation team faced challenges differentiating between CPRIC and ROSC, leading to confusion and perhaps inappropriate interventions. The patient’s motor movements during CPR posed a specific treatment dilemma, as balancing them with uninterrupted CPR and avoiding complications and obstacles in achieving ROSC was essential [ 1 , 2 ]. The causes of CPRIC are still unidentified.…”

“…However, the lack of controlled trials and evidence-based protocols for managing CPRIC contributes to the treatment dilemma faced by healthcare providers. Further study is required to determine whether these people should be physically restrained or sedated [ 2 ]. Further research, a review of reported cases, sedation and medication guidelines, and novel interventions are necessary to guide healthcare providers in making informed treatment decisions and improving outcomes for patients experiencing CPRIC.…”

“…In searching the medical literature, it was found that these movements fit the description of CPRIC. CPRIC includes any level of consciousness with any degree of activity ranging from just opening eyes to even actively grabbing and conversing with medical personnel, despite the absence of a return of spontaneous circulation [1][2][3][4][5][6]. Whether the body movements exhibited by the patient could be included under "consciousness" in "cardiopulmonary resuscitation-induced consciousness" is debatable.…”

“…Cardiopulmonary resuscitation-induced consciousness (CPRIC) is a fascinating and rare phenomenon that has garnered attention in resuscitation medicine. It is described as consciousness during cardiopulmonary resuscitation (CPR), with any degree of activity ranging from just opening eyes to even actively grabbing and conversing with medical personnel, despite the absence of a return of spontaneous circulation [1][2][3]. In this case report, we present the dilemma faced by our resuscitation team when encountering CPRIC in a 55-yearold male patient who ultimately did not survive.…”