CPR induced consciousness.

This study published in the Australasian Emergency Nursing Journal looked at the topic of CPR-induced consciousness (CPRIC). This occurs during cardiac arrest when the effectiveness of CPR produces a transient return to consciousness despite the patient having no inherent effective cardiac output.

The result of this may range from eye opening, ‘agonal’ breathing actions, through to actual attempts to physically interfere with CPR.

To date there have been  a small number of case reports on this phenomenon indicating that up to 11% of survivors of cardiac arrest have memories of the team attempting resuscitation on them. Anecdotal reports suggest that this number is much higher.

There are no current consensus recommendations for management of CPRIC.
The incidence of CPRIC may be higher than thought.
There is a need for the development of management guidelines.

Results:

The study targeted experienced healthcare professionals experiences with CPRIC with the aim of evaluating the need for the development of guidelines to manage this phenomenon. Particularly if it interferes with the resuscitation attempts.

A total of 100 responders completed an online survey. They included consultants, nurses, paramedics and other allied health staff. Thirty two of the respondents had attended greater than 100 arrest situations.

The study found

  • 59% of participants had experience with CPR non-interfering consciousness.
  • 51% of participants had experience with CPR interfering consciousness.

There was often some confusion around management of this situation. It sometimes resulted in a pause or multiple pauses to CPR with pulse and ECG checks.
Many participants reported offering reassurance to the patient during this event.

Management of CPRIC included using sedation and paralysing agents/intubation, and even use of physical restraints.
70% of the participants felt the need for guidelines to manage CPRIC.

The authors concluded:

CPR-induced consciousness is more commonly reported anecdotally, amongst a group of experienced practitioners, than in the medical literature. Impediment to resuscitative efforts was commonly reported and in the absence of clinical guidelines, management was varied. Clinicians desire a uniform management guideline when faced with this clinical scenario. Emergency nurses are a vital part of all resuscitation teams and ideally placed to recog- nise this common phenomenon, and developing, implementing and disseminating guidelines to address consequences of CPR-induced consciousness.

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Reference:

Olaussen, Alexander, Matthew Shepherd, Ziad Nehme, Karen Smith, Paul A. Jennings, Stephen Bernard, and Biswadev Mitra. “CPR-induced consciousness: A cross-sectional study of healthcare practitioners’ experience.” Australasian Emergency Nursing Journal 19, no. 4 (2016): 186-90. doi:10.1016/j.aenj.2016.07.002.

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