CPR induced consciousness: sedation protocols for this special population

Rice, Donald T.; Nudell, Nikiah G.; Habrat, Dorothy; Smith, J. Phillip; Ernest, Eric

doi:10.29045/14784726.2016.1.2.24

Cited by 9 publications

(8 citation statements)

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“…In selected patients in whom significant elevations would be deleterious, the concurrent use of benzodiazepines or the administration of ketamine as a continuous infusion may be appropriate. In several animal studies of cardiac arrest, NMDA receptor antagonism was neuroprotective and positively influenced survival rates [ 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some preclinical studies have demonstrated that pre-treatment with opioids can preserve cellular integrity after acute hypoxia in many organs and tissues such as the brain, myocardium, or intestines. Two retrospective studies have shown that patients receiving opioids before or during cardiac arrest had statistically significantly higher survival rates and better neurological outcomes compared to untreated patients [ 47 , 48 ]. Fentanyl is considered hemodynamically neutral whereas morphine can cause hypotension through peripheral vasodilation [ 49 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

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Analgesic Use in Patients during Cardio-Pulmonary Resuscitation

Dąbrowski

Lange

Basiński

2023

IJERPH

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Introduction: Cardiopulmonary resuscitation-induced consciousness is a newly recognized phenomenon with an increasing incidence. A return of consciousness during cardiopulmonary resuscitation affects up to 0.9% of cases. Patients may also experience physical pain associated with chest compressions, as most victims of cardiac arrest who are subjected to resuscitative efforts sustain ribs or sternum fractures. Methods: A rapid review was carried out from August 2021 to December 2022. Results: Thirty-two articles were included in the rapid review. Of these, eleven studies focused on the return of consciousness during CPR, and twenty-one on CPR-induced chest injuries. Conclusion: A small number of studies that have dealt with the return of consciousness associated with cardiopulmonary resuscitation made it hard to clearly determine how often this occurs. There were more studies that dealt with chest trauma during resuscitation, but no study considered the use of analgesics. Of note, there was no standardized therapeutic approach as far as the use of analgesics and/or sedatives was considered. This is probably due to the lack of guidelines for analgesic management during cardiopulmonary resuscitation and peri-resuscitative period.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Analgesic Use in Patients during Cardio-Pulmonary Resuscitation

Dąbrowski

Lange

Basiński

2023

IJERPH

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“…AWARE 2 recruitment is currently underway [30] looking at whether patients can recall specific noises and images played to them during cardiac arrest. Further case reports have led to calls in some areas for consideration of sedation protocols for those in cardiac arrests [31,32].…”

Section: Psychological Sequelaementioning

confidence: 99%

Intubated, Awake, and Paralysed: A Never Event

Mayberry¹,

Burgart²,

Kanaris³

2021

ICRES

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In this paper, we argue that paralysis-only intubation is almost never acceptable practice. We look at the evidence suggesting that this practice remains commonplace worldwide, its frequency has been exacerbated further by anaesthetic drug shortages secondary to the COVID-19 pandemic. We make a strong case that intubating a patient without sedation has such profound psychological and physiological risks that the practice is unethical and should be banned from medical practice with the exception of two clinical settings. These exceptions include (a) newborn intubation immediately after birth if there is immediate risk to life and (b) awake fibreoptic intubation whereby the patient has consented in advance, co-operative, and the airway has been prepared with local anaesthesia. We further argue that even in cases of cardiopulmonary resuscitation the practice impacts both on patient safety and clinician moral distress and as such in well-resourced times, there can be no justification for harming patients in this way. Formally labelling this practice as a Never Event is a way forward to homogeneously address the risks this archaic practice poses, both to our patients and to ourselves.

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“…5,6,7 CPR-Induced Consciousness occurrence in the prehospital field causes technical and ethical challenges for clinicians both physically and mentally. 7,8,9,10 Despite the recent increase in published material, neither significant research nor clinical trials on CPR-Induced Consciousness have occurred. 2,10,11 Lack of treatment guidelines, data collection, and an agreed upon definition for CPR-Induced Consciousness have restricted advancements on the topic.…”

Section: Introductionmentioning

confidence: 99%

Development of an international prehospital CPR-induced consciousness guideline: A Delphi study

Howard,

Grusd,

Rice

et al. 2023

Paramedicine

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Background Improved prehospital systems are contributing to increased presentations of CPR-Induced Consciousness (CPRIC). Data registries do not report CPRIC presentations and thus continued lack of evidence exists, causing a significant variation of prehospital CPRIC management guidelines. The result is variation in recognizing and managing CPRIC. Steps are needed to improve knowledge of CPRIC and model evidence-based guidelines. Objective An international panel of experts was recruited to create CPRIC definitions, guidelines, and a reporting framework which can be used for reporting purposes. Methods A Delphi methodology was used to gain consensus, defined as ≥70% agreement rate, on three domains or areas of interest: Definition, management guideline and data reporting. Participants were invited from the author's professional organizations, as well as social media outlets to recruit as many international clinicians as possible. The study administered four rounds of online surveys. Each round had multiple consensus statements for participants to respond to. Results Eighty-two percent of panelists reported seeing or managing CPRIC suggesting either improved awareness or increased exposure. Consensus was achieved in all three domains. There was agreement on a clear definition of CPRIC. The panel developed two subgroups of CPRIC; interfering and non-interfering CPRIC. Ketamine was the preferred choice to treat CPRIC. Panelists overwhelmingly felt CPRIC needed to be included into the Utstein guidelines. Conclusions This study successfully created definitions of CPRIC, management guidelines, and a data reporting framework. Using this study as a building block, the study team hopes stronger, evidence-based guidelines can now be researched and published.

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CPR induced consciousness: sedation protocols for this special population

Cited by 9 publications

References 0 publications

Analgesic Use in Patients during Cardio-Pulmonary Resuscitation

Analgesic Use in Patients during Cardio-Pulmonary Resuscitation

Intubated, Awake, and Paralysed: A Never Event

Development of an international prehospital CPR-induced consciousness guideline: A Delphi study

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