ABSTRACTS
Presentation of CPR-Induced Consciousness in the Prehospital Setting: Preliminary Results of an Ongoing International SurveyAuthor: Erin Donathan, MPH, FPC | | Associate Authors: Ginny Renkiewicz, PhD, MHS, Michael Hubble, PhD, MBA
Introduction CPR-induced consciousness (CPR-IC) is defined as signs of life during CPR despite a lack of return of spontaneous circulation. Studies show an increased incidence, in part due to compression-only bystander CPR and the introduction of mechanical compression devices. Although reports of CPR-IC are present in previous literature, there is little consensus regarding presentation or guidance on field management. Objective To explore the presentation and treatment of CPR-IC among a convenience sample of international prehospital clinicians. Methods A solicitation containing a link to a voluntary 36-item Qualtrics survey was emailed by the National Association of Emergency Medical Technicians to 5,512 international and 1,000 U.S. members. The Irish Pre-Hospital Emergency Care Council distributed the survey to an additional 4,226 prehospital clinicians. The survey was translated into 18 languages using professional translators to ensure accuracy and legibility. Results EMS clinicians from 32 countries submitted 832 responses from May through June 2023; 825 respondents consented to participate. After removing incomplete records, 602 remained for analysis, including 341 (56.64%) paramedics, 168 (1.30%) AEMTs, and 319 (32.06%) EMTs. Roughly half (52.99%) of respondents reported having witnessed CPR-IC. Out-of-hospital cardiac arrest was witnessed by a clinician or bystander in 205 (81.67%) cases, and a mechanical CPR device was used in 84 (33.33%). There were multiple presenting cardiac rhythms in CPR-IC patients, including 126 (50.00%) in ventricular fibrillation, 32 (12.70%) in ventricular tachycardia, 40 (15.87%) in pulseless electrical activity (PEA), 9 (3.57%) in idioventricular rhythm, and 35 (17.87%) in asystole. Defibrillation occurred prior to CPR-IC in 139 (55.16%) cases. Neither sedation nor analgesia were provided by clinicians before (71.33%) or after (69.44%) CPR-IC. Paralytics were also not provided prior to (88.10%) or in response to (82.94%) CPR-IC. CPR-IC presented most often as spontaneous eye opening (64.55%), increased jaw tone (59.38%), purposeful eye movement(58.04%), and purposeful (58.04%) or nonpurposeful (57.14%) extremity movement. Clinicians felt CPR-IC disrupted patient care in 90 (35.71%) cases. Overall, 42.06% of clinicians reported having established organizational protocols for CPR-IC. Conclusions CPR-IC was reported by over half of respondents, while only 42.06% reported having established treatment protocols. Evidenced-based education and protocols for CPR-IC are minimally available to clinicians. Additional research is needed to describe this phenomenon and inform best management practices.
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