Prolonged Retention of Awareness During Cardiopulmonary Resuscitation for Asystolic Cardiac Arrest
- 257 Downloads
To describe high level of awareness in a patient undergoing cardiopulmonary resuscitation for an asystolic cardiac arrest and review the literature regarding this phenomenon.
This is a case report of a patient admitted to the Intensive Care Unit who suffered an asystolic cardiac arrest. We reviewed MEDLINE using the terms “awareness,” “consciousness,” “cerebral perfusion,” “sedation,” “analgesia,” “termination,” “cessation,” and “cardiopulmonary resuscitation.”
A 57-year-old man with renal failure suffered asystolic cardiac arrest. He was awake and alert during cardiopulmonary resuscitation (CPR). Cardiac arrest was confirmed by echocardiogram and invasive arterial monitoring. He briskly localized and consistently followed simple commands while chest compressions were in progress before becoming unresponsive and dying after a 3-h resuscitative effort. No sedation/analgesia was used. There are few reports in the literature describing similar events.
It is possible to retain a high level of awareness following cardiac arrest, particularly with effective CPR. Recognition of this situation when it occurs allows appropriate decisions to be made regarding the use of sedation and the length of resuscitative efforts.
KeywordsCardiopulmonary resuscitation Cardiac arrest Awareness Consciousness Sedation
We are very grateful to Dr. Nalini Prabhu, MD and Dr. V. Dedeepiya Devaprasad, MD, DNB, IDCC of the Critical Care department, Apollo Hospitals, who participated in the resuscitation of this patient. We would also like to acknowledge Dr. Rajagopalan Seshadri, MD, Consultant, Department of Nephrology, Apollo Hospitals who was the primary consultant on this patient and Dr. N. Ramakrishnan, head of the Critical Care Department, Apollo Hospitals, Chennai.
- 3.2005 AHA Guidelines for CPR and ECC—management of cardiac arrest. Circulation. 2005;112:IV-58–IV-66.Google Scholar
- 4.Nolan JP, Deakin CD, Soar J, B¨ottiger BW, Smith G. European resuscitation council guidelines for resuscitation 2005 section 4. Adult Adv Life Support Resuscit. 2005;67S1:S39–86.Google Scholar
- 5.Latchaw RE, Yonas H, Hunter GJ, Yuh WT, Ueda T, Sorensen AG, Sunshine JL, Biller J, Wechsler L, Higashida R, Hademenos G. Guidelines and recommendations for perfusion imaging in cerebral ischemia: a scientific statement for healthcare professionals by the writing group on perfusion imaging, from the Council on Cardiovascular Radiology of the American Heart Association. Stroke. 2003;34:1084–104.PubMedCrossRefGoogle Scholar
- 7.Marín-Caballos AJ, Murillo-Cabezas F, Cayuela-Domínguez A, Domínguez-Roldán JM, Rincón-Ferrari MD, Valencia-Anguita J, Flores-Cordero JM, Muñoz-Sánchez MA. Cerebral perfusion pressure and risk of brain hypoxia in severe head injury: a prospective observational study. Crit Care. 2005;9(6):R670–6. Epub 2005 Oct 14.Google Scholar
- 8.Bandera E, Botteri M, Minelli C, Sutton A, Abrams KR, Latronico N. Cerebral blood flow threshold of ischemic penumbra and infarct core in acute ischemic stroke: a systematic review. Stroke. 2006;37(5):1334–9. Epub 2006 Mar 30. Review.Google Scholar
- 17.Abella BS, Sandbo N, Vassilatos P, Alvarado JP, O’Hearn N, Wigder HN, Hoffman P, Tynus K, Vanden Hoek TL, Becker LB. Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest. Circulation. 2005;111:428–34.PubMedCrossRefGoogle Scholar
- 18.2005 AHA Guidelines for CPR and ECC—overview of CPR. Circulation 2005;112:IV-12–IV-8.Google Scholar
- 20.Plaisance P, Lurie KG, Vicaut E, Adnet F, Petit JL, Epain D, Ecollan P, Gruat R, Cavagna P, Biens J, Payen D. A comparison of standard cardiopulmonary resuscitation and active compression–decompression resuscitation for out-of-hospital cardiac arrest. French active compression-decompression cardiopulmonary resuscitation study group. N Engl J Med. 1999;341:569–75.PubMedCrossRefGoogle Scholar
- 21.Cohen TJ, Goldner BG, Maccaro PC, Ardito AP, Trazzera S, Cohen MB, Dibs SR. A comparison of active compression–decompression cardiopulmonary resuscitation with standard cardiopulmonary resuscitation for cardiac arrests occurring in the hospital. N Engl J Med. 1993;329:1918–21.PubMedCrossRefGoogle Scholar
- 24.Stiell I, H’ebert P, Well G, Laupacis A, Vandemheen K, Dreyer J, Eisenhauer M, Gibson J, Higginson L, Kirby A, Mahon J, Maloney J, Weitzman B. The Ontario trial of active compression-decompression cardiopulmonary resuscitation for in-hospital and prehospital cardiac arrest. JAMA. 1996;275:1417–23.PubMedCrossRefGoogle Scholar