Six Cases Of CPR-Induced Consciousness In Witnessed Cardiac Arrest
1) Emergency Department, Policlinico Casilino, Rome, Italy
2) Emergency Department, University Hospital of Padua, Italy
3) Emergency Department, Ospedale Sant’Antonio, Padua, Italy
In a systematic review made by Olaussen, ten cases of CPR-IC are analyzed: a very variable management is observed, with physical or chemical restraints in six patients and no sedation in the remaining four. The authors also hope for an integration of existing guidelines with identification and management of CPR-IC .
Considering the increased attention to prompt initiation of high quality CPR and the diffusion of automatic CPR devices this phenomenon could become more frequent, especially in
cases of bystander witnessed prehospital or intrahospital cardiac arrest. For this reasons the Nebraska Emergency Medical Services has established a sedation protocol for CPR-IC .
granted an exemption from requiring ethics approval.
Consciousness management in these situations is not well known by health-care providers. It could be reasonably considered an index of excellent CPR quality and brain perfusion, although there is no evidence at the moment that could associate it with survival and prognosis. In our experience, four on six patients survived cardiac arrest without neurological impairments after 20 minutes of CPR: further studies are needed to assess these aspects, because it could be considered a reason to prolong resuscitation with the integration, for example, of extra-corporeal circulation (ECMO).
We started manual CCs within 30 seconds from witnessed cardiac arrest. During the first cycles of cardiac arrest algorithm we stopped CPR several times because of misinterpretation with a return of spontaneous circulation (ROSC). After recognizing this situation as CPR-IC we strictly applied ACLS protocol , with rhythm check every 2 minutes. For consciousness management we performed physical restraint and/or analgesia (table 1), although it is not clearly defined in current cardiopulmonary resuscitation guidelines ; similar management strategies are reported by Olaussenn . The Gordian knot is how to promptly recognize differences between vital signs due to ROSC or to CPR-Induced consciousness. In order to solve it, recommendations for the management of CPR-IC should be implemented, with a special focus on sedation.
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