Is It Possible to Maintain Consciousness and Spontaneous Ventilation with Chest Compression in the Early Phase of Cardiac Arrest?

Abstract

Chest compression is important in cardiopulmonary resuscitation. However, life support algorithms do not specify when chest compression should be initiated in patients with persistent spontaneous normal breathing in the early phase after cardiac arrest. Here we describe the case of a 69-year-old man who underwent femoral bypass surgery and was extubated at the end of the procedure. After extubation, the patient's breathing pattern and respiratory rate were normal. The patient subsequently developed ventricular fibrillation, evident on two monitors. Because defibrillation was ineffective, chest compression was initiated even though the patient had spontaneous normal breathing and defensive motor reflexes, which were continued throughout resuscitation. He regained consciousness and underwent tracheal extubation without neurological sequelae on postoperative day 1. This case highlights the necessity of chest compression in the early phase of cardiac arrest.

2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group

“…Twenty-four case reports or series that described 31 cases of consciousness during CPR were published since 1962, with sedative drugs being used in ≈30%. 157–180 Existing drug regimens were identified that included the use of ketamine, midazolam, or fentanyl or a combination of these drugs.…”

Analgesic Use in Patients during Cardio-Pulmonary Resuscitation

“…Chest compressions cause slight but critical blood flow to the brain, and sometimes cerebral perfusion pressure is sufficient to restore the patient’s consciousness, Table 2 [ 4 , 7 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. CPR-induced awareness (CPR-IC) can be defined as the presence of clinical signs of cerebral perfusion during CPR that do not occur when CPR is interrupted [ 15 ].…”

“…During chest compressions with LUCAS device, the patient was provided with adequate perfusion to regain consciousness [ 4 , 7 , 15 , 18 , 20 , 22 ]. During manual chest compressions, returns of consciousness also occurred [ 4 , 15 , 17 , 18 , 19 , 20 , 21 , 22 ]. In the studies by authors Olaussen et al and Grandi et al, the administration of analgesics and sedatives during resuscitation was demonstrated [ 18 , 22 ].…”