Consciousness induced during cardiopulmonary resuscitation: An observational study

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background
Cardiopulmonary resuscitation-induced consciousness (CPRIC) is a phenomenon that has been described in only a handful of case reports. In this study, we aimed to describe CPRIC in out-of-hospital cardiac arrest (OHCA) patients and determine its association with survival outcomes.

Methods
Retrospective study of registry-based data from Victoria, Australia between January 2008 and December 2014. Adult OHCA patients treated by emergency medical services (EMS) were included. Multivariable logistic regression was used to determine the association between CPRIC and survival to hospital discharge.

Results
There were 112 (0.7%) cases of CPRIC among 16,558 EMS attempted resuscitations, increasing in frequency from 0.3% in 2008 to 0.9% in 2014 (p = 0.004). Levels of consciousness consisted of spontaneous eye opening (20.5%), jaw tone (20.5%), speech (29.5%) and/or body movement (87.5%). CPRIC was independently associated with an increased odds of survival to hospital discharge in unwitnessed/bystander witnessed events (OR 2.09, 95% CI: 1.14, 3.81; p = 0.02) but not in EMS witnessed events (OR 0.98, 95% CI: 0.49, 1.96; p = 0.96). Forty-two (37.5%) patients with CPRIC received treatment with one or more of midazolam (35.7%), opiates (5.4%) or muscle relaxants (3.6%). When stratified by use of these medications, CPRIC in unwitnessed/bystander witnessed patients was associated with improved odds of survival to hospital discharge if medications were not given (OR 3.92, 95% CI: 1.66, 9.28; p = 0.002), but did not influence survival if these medications were given (OR 0.97, 95% CI: 0.37, 2.57; p = 0.97).

Conclusion
Although CPRIC is uncommon, its occurrence is increasing and may be associated with improved outcomes. The appropriate management of CPRIC requires further evaluation.
Original languageEnglish
Pages (from-to)44-50
Number of pages7
JournalResuscitation
Volume113
DOIs
Publication statusPublished - 1 Apr 2017

Keywords

  • Awareness
  • Cardiac arrest
  • Cardiopulmonary resuscitation
  • Consciousness

Cite this

@article{660611c5415949d491d629400b86939e,
title = "Consciousness induced during cardiopulmonary resuscitation: An observational study",
abstract = "BackgroundCardiopulmonary resuscitation-induced consciousness (CPRIC) is a phenomenon that has been described in only a handful of case reports. In this study, we aimed to describe CPRIC in out-of-hospital cardiac arrest (OHCA) patients and determine its association with survival outcomes.MethodsRetrospective study of registry-based data from Victoria, Australia between January 2008 and December 2014. Adult OHCA patients treated by emergency medical services (EMS) were included. Multivariable logistic regression was used to determine the association between CPRIC and survival to hospital discharge.ResultsThere were 112 (0.7{\%}) cases of CPRIC among 16,558 EMS attempted resuscitations, increasing in frequency from 0.3{\%} in 2008 to 0.9{\%} in 2014 (p = 0.004). Levels of consciousness consisted of spontaneous eye opening (20.5{\%}), jaw tone (20.5{\%}), speech (29.5{\%}) and/or body movement (87.5{\%}). CPRIC was independently associated with an increased odds of survival to hospital discharge in unwitnessed/bystander witnessed events (OR 2.09, 95{\%} CI: 1.14, 3.81; p = 0.02) but not in EMS witnessed events (OR 0.98, 95{\%} CI: 0.49, 1.96; p = 0.96). Forty-two (37.5{\%}) patients with CPRIC received treatment with one or more of midazolam (35.7{\%}), opiates (5.4{\%}) or muscle relaxants (3.6{\%}). When stratified by use of these medications, CPRIC in unwitnessed/bystander witnessed patients was associated with improved odds of survival to hospital discharge if medications were not given (OR 3.92, 95{\%} CI: 1.66, 9.28; p = 0.002), but did not influence survival if these medications were given (OR 0.97, 95{\%} CI: 0.37, 2.57; p = 0.97).ConclusionAlthough CPRIC is uncommon, its occurrence is increasing and may be associated with improved outcomes. The appropriate management of CPRIC requires further evaluation.",
keywords = "Awareness, Cardiac arrest, Cardiopulmonary resuscitation, Consciousness",
author = "Alexander Olaussen and Ziad Nehme and Matthew Shepherd and Jennings, {Paul A} and Stephen Bernard and Biswadev Mitra and Karen Smith",
year = "2017",
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volume = "113",
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Consciousness induced during cardiopulmonary resuscitation : An observational study. / Olaussen, Alexander; Nehme, Ziad; Shepherd, Matthew; Jennings, Paul A; Bernard, Stephen; Mitra, Biswadev; Smith, Karen.

In: Resuscitation, Vol. 113, 01.04.2017, p. 44-50.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Consciousness induced during cardiopulmonary resuscitation

T2 - An observational study

AU - Olaussen, Alexander

AU - Nehme, Ziad

AU - Shepherd, Matthew

AU - Jennings, Paul A

AU - Bernard, Stephen

AU - Mitra, Biswadev

AU - Smith, Karen

PY - 2017/4/1

Y1 - 2017/4/1

N2 - BackgroundCardiopulmonary resuscitation-induced consciousness (CPRIC) is a phenomenon that has been described in only a handful of case reports. In this study, we aimed to describe CPRIC in out-of-hospital cardiac arrest (OHCA) patients and determine its association with survival outcomes.MethodsRetrospective study of registry-based data from Victoria, Australia between January 2008 and December 2014. Adult OHCA patients treated by emergency medical services (EMS) were included. Multivariable logistic regression was used to determine the association between CPRIC and survival to hospital discharge.ResultsThere were 112 (0.7%) cases of CPRIC among 16,558 EMS attempted resuscitations, increasing in frequency from 0.3% in 2008 to 0.9% in 2014 (p = 0.004). Levels of consciousness consisted of spontaneous eye opening (20.5%), jaw tone (20.5%), speech (29.5%) and/or body movement (87.5%). CPRIC was independently associated with an increased odds of survival to hospital discharge in unwitnessed/bystander witnessed events (OR 2.09, 95% CI: 1.14, 3.81; p = 0.02) but not in EMS witnessed events (OR 0.98, 95% CI: 0.49, 1.96; p = 0.96). Forty-two (37.5%) patients with CPRIC received treatment with one or more of midazolam (35.7%), opiates (5.4%) or muscle relaxants (3.6%). When stratified by use of these medications, CPRIC in unwitnessed/bystander witnessed patients was associated with improved odds of survival to hospital discharge if medications were not given (OR 3.92, 95% CI: 1.66, 9.28; p = 0.002), but did not influence survival if these medications were given (OR 0.97, 95% CI: 0.37, 2.57; p = 0.97).ConclusionAlthough CPRIC is uncommon, its occurrence is increasing and may be associated with improved outcomes. The appropriate management of CPRIC requires further evaluation.

AB - BackgroundCardiopulmonary resuscitation-induced consciousness (CPRIC) is a phenomenon that has been described in only a handful of case reports. In this study, we aimed to describe CPRIC in out-of-hospital cardiac arrest (OHCA) patients and determine its association with survival outcomes.MethodsRetrospective study of registry-based data from Victoria, Australia between January 2008 and December 2014. Adult OHCA patients treated by emergency medical services (EMS) were included. Multivariable logistic regression was used to determine the association between CPRIC and survival to hospital discharge.ResultsThere were 112 (0.7%) cases of CPRIC among 16,558 EMS attempted resuscitations, increasing in frequency from 0.3% in 2008 to 0.9% in 2014 (p = 0.004). Levels of consciousness consisted of spontaneous eye opening (20.5%), jaw tone (20.5%), speech (29.5%) and/or body movement (87.5%). CPRIC was independently associated with an increased odds of survival to hospital discharge in unwitnessed/bystander witnessed events (OR 2.09, 95% CI: 1.14, 3.81; p = 0.02) but not in EMS witnessed events (OR 0.98, 95% CI: 0.49, 1.96; p = 0.96). Forty-two (37.5%) patients with CPRIC received treatment with one or more of midazolam (35.7%), opiates (5.4%) or muscle relaxants (3.6%). When stratified by use of these medications, CPRIC in unwitnessed/bystander witnessed patients was associated with improved odds of survival to hospital discharge if medications were not given (OR 3.92, 95% CI: 1.66, 9.28; p = 0.002), but did not influence survival if these medications were given (OR 0.97, 95% CI: 0.37, 2.57; p = 0.97).ConclusionAlthough CPRIC is uncommon, its occurrence is increasing and may be associated with improved outcomes. The appropriate management of CPRIC requires further evaluation.

KW - Awareness

KW - Cardiac arrest

KW - Cardiopulmonary resuscitation

KW - Consciousness

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U2 - 10.1016/j.resuscitation.2017.01.018

DO - 10.1016/j.resuscitation.2017.01.018

M3 - Article

VL - 113

SP - 44

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JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

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