Prolonged Retention of Awareness During Cardiopulmonary Resuscitation for Asystolic Cardiac Arrest
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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.
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