Consciousness induced during cardiopulmonary resuscitation: An observational study

被引:19
作者
Olaussen, Alexander [1 ,2 ,3 ]
Nehme, Ziad [1 ,4 ,5 ,6 ]
Shepherd, Matthew [1 ,6 ]
Jennings, Paul A. [1 ,2 ,6 ,7 ]
Bernard, Stephen [4 ,5 ]
Mitra, Biswadev [2 ,3 ,5 ]
Smith, Karen [1 ,4 ,5 ,8 ]
机构
[1] Monash Univ, Dept Community Emergency Hlth & Paramed Practice, Frankston, Vic, Australia
[2] Alfred Hosp, Emergency & Trauma Ctr, Melbourne, Vic, Australia
[3] Alfred Hosp, Natl Trauma Res Inst, Melbourne, Vic, Australia
[4] Ambulance Victoria, Dept Res & Evaluat, 375 Manningham Rd, Doncaster, Vic 3108, Australia
[5] Monash Univ, Dept Epidemiol & Prevent Med, Melbourne, Vic, Australia
[6] Ambulance Victoria, Dept Emergency Operat, Doncaster, Vic, Australia
[7] Victoria Univ, Coll Hlth & Biomed, Melbourne, Vic, Australia
[8] Univ Western Australia, Sch Primary Aboriginal & Rural Hlth Care, Discipline Emergency Med, Crawley, WA, Australia
关键词
Cardiac arrest; Cardiopulmonary resuscitation; Consciousness; Awareness; CEREBRAL PERFUSION-PRESSURE; CARDIAC-ARREST; BLOOD-FLOW; SURVIVAL; CPR; OXIMETRY; RETURN;
D O I
10.1016/j.resuscitation.2017.01.018
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Cardiopulmonary resuscitation-induced consciousness (CPRIC) is a phenomenon that has been described in only a handful of case reports. In this study, we aimed to describe CPRIC in out-of hospital cardiac arrest (OHCA) patients and determine its association with survival outcomes. Methods: Retrospective study of registry-based data from Victoria, Australia between January 2008 and December 2014. Adult OHCA patients treated by emergency medical services (EMS) were included. Multi variable logistic regression was used to determine the association between CPRIC and survival to hospital discharge. Results: There were 112 (0.7%) cases of CPRIC among 16,558 EMS attempted resuscitations, increasing in frequency from 0.3% in 2008 to 0.9% in 2014 (p = 0.004). Levels of consciousness consisted of spontaneous eye opening (20.5%), jaw tone (20.5%), speech (29.5%) and/or body movement (87.5%). CPRIC was independently associated with an increased odds of survival to hospital discharge in unwitnessed/bystander witnessed events (OR 2.09, 95% CI: 1.14, 3.81; p = 0.02) but not in EMS witnessed events (OR 0.98, 95% CI: 0.49, 1.96; p = 0.96). Forty-two (37.5%) patients with CPRIC received treatment with one or more of midazolam (35.7%), opiates (5.4%) or muscle relaxants (3.6%). When stratified by use of these medications, CPRIC in unwitnessed/bystander witnessed patients was associated with improved odds of survival to hospital discharge if medications were not given (OR 3.92, 95% CI: 1.66, 9.28; p = 0.002), but did not influence survival if these medications were given (OR 0.97, 95% CI: 0.37, 2.57; p = 0.97). Conclusion: Although CPRIC is uncommon, its occurrence is increasing and may be associated with improved outcomes. The appropriate management of CPRIC requires further evaluation. (C) 2017 Elsevier B.V. All rights reserved.
引用
收藏
页码:44 / 50
页数:7
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