Return of consciousness during ongoing cardiopulmonary resuscitation: A systematic review

Olaussen, Alexander; Shepherd, Matthew; Nehme, Ziad; Smith, Karen; Bernard, Stephen; Mitra, Biswadev

doi:10.1016/j.resuscitation.2014.10.017

Cited by 42 publications

(41 citation statements)

References 25 publications

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“…The next day, the patient had an awareness of being alive and memories during the resuscitation. High-quality chest compressions and ventilation can generate sufficient circulation and brain oxygenation to restore signs of life [14]. CPR-induced consciousness has been described in varying levels, ranging from mild eye opening and breathing to active interference of the rescuers' CPR attempts.…”

Section: Discussionmentioning

confidence: 99%

Resuscitation following a bupivacaine injection for a cervical paravertebral block

et al. 2019

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AbstractBackgroundCardiac arrest related to nerve blockade using a local anaesthetic is a rare event. We report a case of bupivacaine severe cardiovascular toxicity following cervical paravertebral nerve block.Case presentationA 44-year-old female was admitted to Republican Vilnius University Hospital, with symptoms of sustained severe pain in her neck that radiated to both arms. Multiple cervical intervertebral hernias with spinal stenosis were confirmed by magnetic resonance imaging. Following infiltration of the subcutaneous tissue with a 0.5 % bupivacaine solution, an 18-gauge spinal needle was used to perform the paravertebral block at the C6 level. Bupivacaine was injected in incremental doses to a total of 10 mL. Rapid loss of consciousness and cardiovascular collapse suggested a neuraxial injection of bupivacaine. Long-lasting cardiopulmonary resuscitation, including chest compressions, defibrillation attempts for refractory ventricular fibrillation, medications, mechanical ventilation, and intravenous lipid emulsion infusion, was successful. No severe adverse outcomes other than acute kidney injury and chest pain related to prolonged chest compressions were documented.ConclusionsThis case report emphasizes the necessity of ensuring adequate safety precautions to avoid local anaesthetic systemic toxicity. Lipid emulsion preparations should be available in all hospital settings where local anaesthetics are used for regional anaesthesia or pain management.

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Section: Discussionmentioning

confidence: 99%

Resuscitation following a bupivacaine injection for a cervical paravertebral block

et al. 2019

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“…A patient making purposeful movements, even being awake and alert while in cardiac arrest, can have profound emotional and psychological implications on the patient as well as the paramedic providers caring for them. 3 An unintended consequence of improving resuscitation techniques may be that we are subjecting 'aware' patients to psychological trauma and the physical pain of CPR with increasing frequency. Of additional concern is the physiological response to these factors and their impact on critically ill patients in the pre-, peri-, and post-arrest phases.…”

Section: Sirmentioning

confidence: 99%

CPR induced consciousness: It's time for sedation protocols for this growing population

Rice

Nudell²,

Habrat

et al. 2016

Resuscitation

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“…Although CPR typically generates only a fraction of the perfusion required to maintain normal functioning, when performed optimally, it can generate cerebral perfusion that may be sufficient for the patient to regain some level of consciousness . CPR‐induced consciousness provides challenges to paramedics, potentially impeding successful resuscitative efforts . Patients gaining consciousness during CPR can interfere with the resuscitation by pushing and grabbing the resuscitator, withdrawing from the compressions, and pulling out airway‐securing devices .…”

Section: Introductionmentioning

confidence: 99%

“…CPR‐induced consciousness provides challenges to paramedics, potentially impeding successful resuscitative efforts . Patients gaining consciousness during CPR can interfere with the resuscitation by pushing and grabbing the resuscitator, withdrawing from the compressions, and pulling out airway‐securing devices . Patient consciousness can also lead to CPR being interrupted more frequently for pulse checks…”

Section: Introductionmentioning

confidence: 99%

Insights into the epidemiology of cardiopulmonary resuscitation‐induced consciousness in out‐of‐hospital cardiac arrest

Doan

Adams

Schultz

et al. 2020

Emerg Medicine Australasia

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Objectives: To describe the characteristics and outcomes of cardiopulmonary resuscitation (CPR)-induced consciousness patients from a large database of out-of-hospital cardiac arrest (OHCA). Methods: Included were adult patients, attended between January 2007 and December 2018 by the Queensland Ambulance Service, where resuscitation was attempted by paramedics. Manual review of records was undertaken to identify CPR-induced consciousness cases. Patients exhibiting purposeful limb/ body movement during CPR, with or without displaying other signs, were considered to be CPR-induced consciousness. Characteristics and outcomes of CPR-induced consciousness patients were compared to those without CPR-induced consciousness. Results: A total of 23 011 OHCA patients were included; of these, 52 (0.23%) were CPR-induced consciousness. This translates into an incidence rate of 2.3 cases per 1000 adult resuscitation attempts over 12 years. Combativeness/agitation was the most common sign of CPR-induced consciousness, described in 34.6% (18/52) of patients. CPR-induced consciousness patients had numerically higher rates of return of spontaneous circulation on hospital arrival (51.9% vs 28.6%), discharge survival (46.2% vs 15.1%) and 30-day survival (46.2% vs 14.7%), than those without CPR-induced consciousness; however, CPR-induced consciousness was not found to be an independent predictor of survival. Higher proportions of CPR-induced consciousness patients had arrest witnessed by paramedics, occurring in public places, of cardiac aetiology and initial shockable rhythm, than patients without CPRinduced consciousness. Conclusions: CPR-induced consciousness in OHCA appears to be associated with higher survival rates. Standardised guidelines on recognition and management of CPR-induced consciousness remain to be established.

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Return of consciousness during ongoing cardiopulmonary resuscitation: A systematic review

Cited by 42 publications

References 25 publications

Resuscitation following a bupivacaine injection for a cervical paravertebral block

Resuscitation following a bupivacaine injection for a cervical paravertebral block

CPR induced consciousness: It's time for sedation protocols for this growing population

Insights into the epidemiology of cardiopulmonary resuscitation‐induced consciousness in out‐of‐hospital cardiac arrest

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