Management Challenges of Interfering Cardiopulmonary Resuscitation-Induced Consciousness in the Prehospital Setting: A Case Report.

BACKGROUND Cardiopulmonary resuscitation-induced consciousness (CPRIC) is a rare phenomenon in which patients in cardiac arrest demonstrate signs of consciousness while undergoing cardiopulmonary resuscitation (CPR). Only a few cases of this phenomenon are reported in the literature. Previous studies estimate that CPRIC occurs in 0.23-0.9% of all cardiac arrests, with prevalence increasing over recent years. It has been proposed that the etiology of this phenomenon is the result of preserved cerebral perfusion during high-quality CPR. CASE REPORT A 52-year-old woman presented with witnessed out-of-hospital cardiac arrest after a bout of chest pain. During CPR, resuscitation was stopped multiple times due to signs of consciousness despite the patient being in ventricular fibrillation. Throughout the resuscitation attempt, the patient grunted, yelled, demonstrated purposeful movements, and opened her eyes. These actions resulted in considerable pauses in chest compressions, delays in routine advanced cardiac life support interventions, and psychological distress to the emergency medical services clinicians. After multiple defibrillations, the patient was successfully resuscitated and became oriented enough to answer questions and hold meaningful discussion. She was transported directly to the cardiac catheterization lab, where she underwent percutaneous coronary intervention to correct a 100% occlusive in-stent thrombosis of the mid-left anterior descending artery. CONCLUSIONS This case describes challenges health care professionals might face when CPRIC occurs. While sedation was considered, widespread protocols for sedation in CPRIC patients do not exist. More research is needed to determine the prevalence of CPRIC in the United States, as well as best practices for management of this rare phenomenon, for the safety of both patient and health care professionals.