Doctor: Patient stayed awake through 90 minutes of CPR
A case report said that a man was showing unusual signs of conscious awareness while a medical team performed CPR on him after he suffered cardiac arrest
By EMS1 Staff
COPENHAGEN, Denmark — A new case report said a man who underwent cardiac arrest showed unusual signs of conscious awareness while a medical crew performed CPR on him.
CNN reported that the medical team performed CPR on the 69-year-old man for 90 minutes when he suffered cardiac arrest shortly after being admitted to a hospital for indigestion and nausea.
"At this time, paramedics were still in the room, and CPR was initiated immediately,” Dr. Rune Sarauw Lundsgaard said. “Due to a recent event with another patient, the cardiac arrest team was in the next room, and advanced CPR was initiated shortly after. This means that two paramedics and four hospital porters were shifting in pairs of two at performing the CPR. The patient had no electrical activity in the heart at any time. The heart only functioned because of the manual compressions.”
Lundsgaard said the patient occasionally showed signs of conscious awareness while CPR was performed on him.
"As soon as CPR was initiated, the patient opened his eyes,” he said. “When CPR was performed, the patient was able to respond to verbal communication by moving eyes, lifting hands and legs and nodding his head. The patient's wife was present and able to hold his hand.”
Dr. Sam Parnia, who led a study on the topic in 2014, said it is extremely unusual for patients to show such a level of consciousness during CPR.
"It is exceedingly rare for people to have actual awareness with external signs of being conscious as is being discussed in this case report," Parnia said. "All the studies of CPR have demonstrated that there is insufficient blood flow to the brain (approximately 15 percent of baseline blood flow) to allow for the return of brain stem reflexes and consciousness with external signs of being awake.”
Parnia added that “it is much more likely to have people waking up during compressions when the additive effect on an already beating heart raises the blood pressure to a sufficient level to provide enough blood flow to the brain.”
Lundsgaard said CPR is usually stopped when a patient begins to appear conscious.
"Normally, chest compressions are stopped once the patient shows signs of life or spontaneous breathing,” he said. [When] the patient moved, we stopped CPR, and immediately the patient went unconscious due to his nonfunctioning heart. This was done several times with the same result.”
Dr. Parnia said the team performed CPR for much longer than is customary.
"Most hospitals will stop at around 20 minutes. However, based on results of studies, it is recommended to continue for at least 45 minutes. This is unusual," he said.
Despite the lifesaving efforts, the team was unable to save the patient.
"The cardiac arrest team in our case was very affected by the situation," Lundsgaard said. "For me, having to tell the patient that we were unable to save his life ... and that in a minute we will stop chest compressions and you will not survive was a challenging situation."
Lundsgaard said the incident brought up the issue of sedating patients during CPR.
"The question of sedation during CPR is not new, but sedation is not routinely performed during CPR," he said. "We know from anesthesia that accidental awareness during operations often leads to post-traumatic distress and decreased quality of life. One might suspect that awareness during CPR may be just as stressful.”