The Best of the Rest
Critical Care Olaussen A, et al. Consciousness induced during cardiopulmonary resuscitation: An observational study. Resuscitation 2017. PMID: 28161214
- I have had this happen to me. Start chest compressions, the patient is awake; stop, and he is dead. I have struggled with this throughout a 2 hour code, and have discussed it with the patient months later. Thankfully he is alive. Unfortunately, he still suffers from nightmares and flashbacks to that resuscitation. This is a retrospective registry-based study from Australia looking at more than 16,000 EMS based resuscitation. There were 112 (0.7%) cases of CPR induced consciousness identified. The incidence increased from 2003 to 2014. The outcomes in these patients were excellent (43% survival to hospital discharge), despite the fact that CPR was presumably stopped repeatedly in the face of consciousness. There are a ton of problems with this data, as identifying these cases retrospectively is fraught with error, but the point is this happens and you need to have a plan. In the future, I would use ketamine as my sedative of choice here. Bottom line: Good quality CPR can result in consciousness. The outcomes are good, but have a plan to manage this awareness.
- Recommended by: Justin Morgenstern