AWAreness during REsuscitation - II: A Multi-Center Study of Consciousness and Awareness in Cardiac Arrest.
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Author
Parnia, SamKeshavarz Shirazi, Tara
Patel, Jignesh
Tran, Linh
Sinha, Niraj
O'Neill, Caitlin
Roellke, Emma
Mengotto, Amanda
Findlay, Shannon
McBrine, Michael
Spiegel, Rebecca
Tarpey, Thaddeus
Huppert, Elise
Jaffe, Ian
Gonzales, Anelly M
Xu, Jing
Koopman, Emmeline
Perkins, Gavin D
Vuylsteke, Alain
Bloom, Benjamin M
Jarman, Heather
Nam Tong, Hiu
Chan, Louisa
Lyaker, Michael
Thomas, Matthew
Velchev, Veselin
Cairns, Charles B
Sharm, Rahul
Kulstad, Erik
Scherer, Elizabeth
O'Keeffe, Terence
Foroozesh, Mahtab
Abe, Olumayowa
Ogedegbe, Chinwe
Girgis, Amira
Pradhan, Deepak
Deakin, Charles D
Publication date
2023-07-07
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Introduction: Cognitive activity and awareness during cardiac arrest (CA) are reported but ill understood. This first of a kind study examined consciousness and its underlying electrocortical biomarkers during cardiopulmonary resuscitation (CPR). Methods: In a prospective 25-site in-hospital study, we incorporated a) independent audiovisual testing of awareness, including explicit and implicit learning using a computer and headphones, with b) continuous real-time electroencephalography(EEG) and cerebral oxygenation(rSO2) monitoring into CPR during in-hospital CA (IHCA). Survivors underwent interviews to examine for recall of awareness and cognitive experiences. A complementary cross-sectional community CA study provided added insights regarding survivors' experiences. Results: Of 567 IHCA, 53(9.3%) survived, 28 of these (52.8%) completed interviews, and 11(39.3%) reported CA memories/perceptions suggestive of consciousness. Four categories of experiences emerged: 1) emergence from coma during CPR (CPR-induced consciousness [CPRIC]) 2/28(7.1%), or 2) in the post-resuscitation period 2/28(7.1%), 3) dream-like experiences 3/28(10.7%), 4) transcendent recalled experience of death (RED) 6/28(21.4%). In the cross-sectional arm, 126 community CA survivors' experiences reinforced these categories and identified another: delusions (misattribution of medical events). Low survival limited the ability to examine for implicit learning. Nobody identified the visual image, 1/28(3.5%) identified the auditory stimulus. Despite marked cerebral ischemia (Mean rSO2=43%) normal EEG activity (delta, theta and alpha) consistent with consciousness emerged as long as 35-60 minutes into CPR. Conclusions: Consciousness. awareness and cognitive processes may occur during CA. The emergence of normal EEG may reflect a resumption of a network-level of cognitive activity, and a biomarker of consciousness, lucidity and RED (authentic "near-death" experiences).Citation
Parnia S, Keshavarz Shirazi T, Patel J, Tran L, Sinha N, O'Neill C, Roellke E, Mengotto A, Findlay S, McBrine M, Spiegel R, Tarpey T, Huppert E, Jaffe I, Gonzales AM, Xu J, Koopman E, Perkins GD, Vuylsteke A, Bloom BM, Jarman H, Nam Tong H, Chan L, Lyaker M, Thomas M, Velchev V, Cairns CB, Sharm R, Kulstad E, Scherer E, O'Keeffe T, Foroozesh M, Abe O, Ogedegbe C, Girgis A, Pradhan D, Deakin CD. AWAreness during REsuscitation - II: A Multi-Center Study of Consciousness and Awareness in Cardiac Arrest. Resuscitation. 2023 Jul 7:109903. doi: 10.1016/j.resuscitation.2023.109903. Epub ahead of print. PMID: 37423492.Type
ArticlePMID
37423492Journal
ResuscitationPublisher
Elsevierae974a485f413a2113503eed53cd6c53
10.1016/j.resuscitation.2023.109903