Abstract
Objective
To describe high level of awareness in a patient undergoing cardiopulmonary resuscitation for an asystolic cardiac arrest and review the literature regarding this phenomenon.
Methods
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.”
Results
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.
Conclusion
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.
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References
Lewinter JR, Carden DL, Nowak RM, Enriquez E, Martin GB. CPR-dependent consciousness: evidence for cardiac compression causing forward flow. Ann Emerg Med. 1989;18(10):1111–5.
Quinn JV, Hebert PC, Stiell IG. Need for sedation in a patient undergoing active compression–decompression cardiopulmonary resuscitation. Acad Emerg Med. 1994;1(5):463–6.
2005 AHA Guidelines for CPR and ECC—management of cardiac arrest. Circulation. 2005;112:IV-58–IV-66.
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.
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.
Moppett IK, Hardman JG. Modeling the causes of variation in brain tissue oxygenation. Anesth Analg. 2007;105(4):1104–12.
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.
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.
Ochoa FJ, Ramalle-Gomara E, Carpintero JM, Garcia A, Saralegui I. Competence of health professionals to check the carotid pulse. Resuscitation. 1998;37(3):173–5.
Eberle B, Dick WF, Schneider T, Wisser G, Doetsch S, Tzanova I. Checking the carotid pulse check: diagnostic accuracy of first responders in patients with and without a pulse. Resuscitation. 1996;33(2):107–16.
Martens P, Mullie A. Sedation during and after CPR, is it worth a guideline? Resuscitation. 1995;29(3):223–4.
Van Hoeyweghen R, Mullie A, Bossaert L. Decision making in continuing or cease cardiopulmonary resuscitation (CPR), cerebral resuscitation study group. Resuscitation. 1989;17(Suppl):S137–47.
Delooz HH, Lewi PJ. Early prognostic indices after cardiopulmonary resuscitation (CPR), cerebral resuscitation study group. Resuscitation. 1989;17(Suppl):S149–55.
Martens PR, Mullie A, Buylaert W, Calle P, van Hoeyweghen R. Early prediction of non-survival for patients suffering cardiac arrest-a word of caution. The Belgian cerebral resuscitation study group. Intensive Care Med. 1992;18(1):11–4.
Eftestol T, Sunde K, Steen PA. Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest. Circulation. 2002;105:2270–3.
Yu T, Weil MH, Tang W, Sun S, Klouche K, Povoas H, Bisera J. Adverse outcomes of interrupted precordial compression during automated defibrillation. Circulation. 2002;106:368–72.
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.
2005 AHA Guidelines for CPR and ECC—overview of CPR. Circulation 2005;112:IV-12–IV-8.
Timerman S, Cardoso LF, Ramires JA, Halperin H. Improved hemodynamic performance with a novel chest compression device during treatment of in-hospital cardiac arrest. Resuscitation. 2004;61(3):273–80.
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.
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.
Tucker KJ, Galli F, Savitt MA, Kahsai D, Bresnahan L, Redberg RF. Active compression–decompression resuscitation: effect on resuscitation success after in-hospital cardiac arrest. J Am Coll Cardiol. 1994;24:201–9.
Schwab TM, Callaham ML, Madsen CD, Utecht TA. A randomized clinical trial of active compression–decompression CPR vs standard CPR in out-of-hospital cardiac arrest in two cities. JAMA. 1995;273:1261–8.
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.
Nolan J, Smith G, Evans R, McCusker K, Lubas P, Parr M, Baskett P. The United Kingdom pre-hospital study of active compression–decompression resuscitation. Resuscitation. 1998;37:119–25.
Acknowledgments
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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This case report was approved by the Ethics Committee of Apollo Hospitals, Chennai.
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Bihari, S., Rajajee, V. Prolonged Retention of Awareness During Cardiopulmonary Resuscitation for Asystolic Cardiac Arrest. Neurocrit Care 9, 382–386 (2008). https://doi.org/10.1007/s12028-008-9099-2
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DOI: https://doi.org/10.1007/s12028-008-9099-2