CPR‑Induced Consciousness From The Patient Perspective A Case Report
Article Sidebar
Main Article Content
Abstract
Background: Cardiopulmonary resuscitation‑induced consciousness (CPRIC) is increasingly recognized during high‑quality chest compressions, but the patient’s lived experience is under‑reported.
Case: A 70‑year‑old man collapsed from witnessed ventricular fibrillation (VF) arrest. Bystanders began CPR within two minutes; EMS arrived at ten minutes. During compressions he displayed eye opening, groaning, lateral rolling, and purposeful localization that intermittently impeded compressions. Airway adjuncts were limited by trismus; bilateral nasopharyngeal airways and two‑person bag‑valve‑mask ventilation were used. Three 200 J shocks were delivered; return of spontaneous circulation occurred approximately 17 minutes after collapse.
Patient perspective: Post‑event he described vivid, dream‑like awareness of being restrained and struggling to breathe described as “almost like being buried alive” without sound or ability to communicate. He recalled sharp left tibial pain with intraosseous access, the road journey, and emergency department handover.
Outcomes: Coronary angiography showed no obstructive disease. An implantable cardioverter‑defibrillator was placed. He was discharged neurologically intact.
Conclusion: Patients may form explicit and distressing memories during CPR and early post‑ROSC. Anticipatory communication, rapid recognition of interfering CPRIC, and titrated sedation/analgesia may improve care while preserving CPR quality. Systems should include structured follow‑up to address psychological sequelae.
Article Details
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Publishing in IJOP allows authors to keep their copyright while giving IJOP unrestricted copyright permissions. Articles published in IJOP use Creative Common Attribution 4.0 International (CC BY-ND 4.0) licensing. This license requires that re-users give credit to the creator. It allows re-users to copy and distribute the material in any medium or format in unadapted form only, even for commercial purposes. Additional terms apply and can be accessed here.
Publishing in IJOP also allows authors to have contracts for non-exclusive distribution of the Journal's published version of the article, such as posting to an institutional repository or publication in a book, on the condition that the original publication in the original layout format in IJOP is retained and acknowledged.
We permit and encourage authors to post the articles they published in IJOP on their affiliated websites. This helps share the information, encourages citation in other works, and promotes scholarly discourse in the spirit of open access.
References
Al Atbi, Y. H., Al Mandhari, A., & Al Reesi, A. (2022). Cardiopulmonary resuscitation‑induced consciousness: Case report. Oman Medical Journal, 37(2), e356. https://doi.org/10.5001/omj.2021.51
Brede, J. R., Skjærseth, E. Å., & Rehn, M. (2024). Prehospital anaesthesiologists’ experience with cardiopulmonary resuscitation‑induced consciousness in Norway – A national cross‑sectional survey. Resuscitation Plus, 18, 100591. https://doi.org/10.1016/j.resplu.2024.100591
Doan, T. N., Adams, L., Schultz, B. V., Bunting, D., Parker, L., Rashford, S., & Bosley, E. (2020). Insights into the epidemiology of cardiopulmonary resuscitation‑induced consciousness in out‑of‑hospital cardiac arrest. Emergency Medicine Australasia, 32(5), 769–776. https://doi.org/10.1111/1742-6723.13505
Olaussen, A., Nehme, Z., Shepherd, M., Jennings, P. A., Bernard, S., Mitra, B., & Smith, K. (2017). Consciousness induced during cardiopulmonary resuscitation: An observational study. Resuscitation, 113, 44–50. https://doi.org/10.1016/j.resuscitation.2017.01.018
Howard, J. H., Grusd, E., Rice, D., Nudell, N. G., Lipscombe, C., Shepherd, M., & Olaussen, A. (2024). Development of an international prehospital CPR‑induced consciousness guideline: A Delphi study. Paramedicine, 21(2), 66–78. https://doi.org/10.1177/27536386231215608
Howard, J. H., Lipscombe, C., Beovich, B., Shepherd, M., Grusd, E., Nudell, N. G., Rice, D., & Olaussen, A. (2022). Pre‑hospital guidelines for CPR‑induced consciousness (CPRIC): A scoping review. Resuscitation Plus, 12, 100335. https://doi.org/10.1016/j.resplu.2022.100335
Kalawila, A. U., & Weerasingha, H. M. (2024). Consciousness during cardiopulmonary resuscitation: A case report. Medical Research Archives, 12(11). https://doi.org/10.18103/mra.v12i11.5908
Medical Advisory Committee, Ambulance Victoria. (2021, March 17). Management of patient agitation – intra‑arrest and post‑ROSC. https://www.ambulance.vic.gov.au/clinical-practice-guidelines
Mittelman, A., McCabe, K., Koul, R., Cuadra, K., Hoopes, R., & Flores‑Cortez, V., & Avery, C. (2024). Consciousness in cardiac arrest: A case report. Journal of Clinical Images and Medical Case Reports, 5. https://doi.org/10.52768/2766-7820/3050
Park, S., Lee, S. W., Han, K. S., Lee, E. J., Jang, D.‑H., Lee, S. J., & Kim, S.J. (2022). Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out‑of‑hospital cardiac arrest. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 30, Article 5. https://doi.org/10.1186/s13049-022-00993-8
Parnia, S., Shirazi, T. K., Patel, J., Tran, L., Sinha, N., O’Neill, C., Roellke, E., Mengotto, A., Findlay, S., McBrine, M., Spiegel, R., Tarpey, T., Huppert, E., Jaffe, I., Gonzales, A. M., Xu, J., Koopman, E., Perkins, G. D., Vuylsteke, A., … Deakin, C.D. (2023). AWAreness during Resuscitation ‑ II: A multi‑center study of consciousness and awareness in cardiac arrest. Resuscitation, 191, 109903. https://doi.org/10.1016/j.resuscitation.2023.109903
Pinto, J., Almeida, P., Ribeiro, F., & Simões, R. (2020). Cardiopulmonary resuscitation‑induced consciousness: A case report in an elderly patient. European Journal of Case Reports in Internal Medicine, 7(2), 001409. https://doi.org/10.12890/2020_001409
Pound, J., Verbeek, P. R., & Cheskes, S. (2017). CPR‑induced consciousness during out‑of‑hospital cardiac arrest: A case report on an emerging phenomenon. Prehospital Emergency Care, 21(2), 252–256. https://doi.org/10.1080/10903127.2016.1229823
Pourmand, A., Hill, B., Yamane, D., & Kuhl, E. (2019). Approach to cardiopulmonary resuscitation‑induced consciousness: An emergency medicine perspective. American Journal of Emergency Medicine, 37(4), 751–756. https://doi.org/10.1016/j.ajem.2019.01.051
Rice, D. T., Nudell, N. G., Habrat, D. A., Smith, J. E., & Ernest, E. V. (2016). CPR‑induced consciousness: It’s time for sedation protocols for this growing population. Resuscitation, 103, e15–e16. https://doi.org/10.1016/j.resuscitation.2016.02.013
Sawyer, K. N., Camp‑Rogers, T. R., Kotini‑Shah, P., Del Rios, M., Gossip, M. R., Moitra, V. K., Haywood, K. L., Dougherty, C. M., Lubitz, S. A., Rabinstein, A. A., Rittenberger, J. C., Callaway, C. W., Abella, B. S., Geocadin, R. G., & Kurz, M. C. (2020). Sudden cardiac arrest survivorship: A scientific statement from the American Heart Association. Circulation, 141(12), e654–e685. https://doi.org/10.1161/CIR.0000000000000747
Silvestri, L., Soh, R., Newton, A., & Pearce, J. (2023). Out‑of‑hospital care of patients experiencing CPR‑induced consciousness: A scoping review. International Paramedic Practice, 13(2), 27–32. https://doi.org/10.12968/ippr.2023.13.2.27
Talikowska, M., Belcher, J., Ball, S., Majewski, D., & Finn, J. (2024). CPR‑induced consciousness in out‑of‑hospital cardiac arrest patients in Western Australia: Case characteristics and CPR quality. Resuscitation, 201, 110278. https://doi.org/10.1016/j.resuscitation.2024.110278
Wagner, M. K., Hirsch, L. F., Berg, S. K., Hassager, C., Borregaard, B., Rasmussen, T. B., Ekholm, O., & Stenbæk, D. S. (2025). Clinical utility of the Impact of Event Scale‑Revised for identifying Acute Stress Disorder in survivors of sudden out‑of‑hospital cardiac arrest: Results from the multicenter REVIVAL cohort. Resuscitation, 209, 110558. https://doi.org/10.1016/j.resuscitation.2025.110558
West, R. L., Otto, Q., Drennan, I. R., Rudd, S., Parnia, S., Böttiger, B. W., & Soar, J. (2021, February 1). CPR‑related cognitive activity, consciousness, awareness and recall and its management: Scoping review and task force insights. International Liaison Committee on Resuscitation (ILCOR). https://costr.ilcor.org/document/consciousness-during-cpr-als-tf-scoping-review
Zhou, X., & Sun, B. (2024). CPR‑induced consciousness during ventricular fibrillation: Case report and literature review. Emergency Medicine International, 2024, 2834376. https://doi.org/10.1155/2024/2834376