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CPR-induced consciousness: A cross-sectional study of healthcare practitioners' experience
Alexander Olaussen1, Matthew Shepherd2, Ziad Nehme3
1Department of Community Emergency Health and Paramedic Practice, Monash University, Australia; Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia; Trauma Service, The Alfred Hospital, Melbourne, Australia.
Introduction:
Consciousness may occur during effective management of cardiac arrest and ranges from eye opening to interfering with rescuers' resuscitation attempts. Reported cases in the medical literature appear scant compared to anecdotal reports. The aim of this study was to evaluate health care providers' experience with consciousness during cardio-pulmonary resuscitation (CPR).
Methods:
A cross-sectional survey of 100 experienced health care professionals, including doctors, nurses and paramedics. Participants were asked about their experience with both CPR-non-interfering consciousness (e.g. eye opening, agonal breaths or mild restlessness) and CPR-interfering consciousness (e.g. purposeful movement, withdrawing from CPR, attempting to pull out airway-securing devices).
Results:
A third of responders reported attending more than 100 cases of arrests, while another third had attended 20 or less arrests. The responders had a mean of 11 (SD 8.7) years of practice. Most responders (59 of 67) to the question had experienced CPR-non-interfering consciousness and reported experiencing it a median of 3 (IQR 1-5) times. CPR-interfering consciousness had been experienced by 51 of the 63 responders and was experienced overall 1 (IQR 1-3) time. Management of these cases varied widely with varied opinion on ideal management ranging from no action to sedation and/or paralysis. A guideline describing the management of this presentation was considered necessary by 40 out of 57 (70%) responders.
Conclusions:
Contrasting to a few reports in the medical literature, CPR-induced consciousness appears to be experienced more commonly during resuscitation. Management strategies varied widely and clinician opinion of ideal management was also varied. The desire for consensus guidelines on this topic exists. Acute care nurses are integral members of all resuscitation teams and in conjunction with other clinicians, ideally placed to develop, implement and disseminate such guidelines to delivering evidence based care to this sub-group of patients.
