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.
Keywords
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Article info
Publication history
Published online: February 01, 2017
Accepted:
January 21,
2017
Received in revised form:
December 22,
2016
Received:
September 29,
2016
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2017.01.018.
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
