Hugh Greenbaum

CPR Induced Consciousness is being described more frequently in emergency medical literature, partially (I suspect) because of improved CPR technique, CPR devices, and increased by-stander CPR.  Most of the cases described in the literature have over indications, such as the patient actively "fighting" providers during compressions.  My interest is in the more subtle cases, where the patient may be aware but not "active".  My hypothesis is that we can recognize these cases through ETCO2 measurements.  I need some help finding literature (research articles, case reports, etc.) in this arena that includes ETCO2 measurements.

So far I've found one case report that included ETCO2 measurements from the EMS report, and one article that relates ETCO2 measurements to a brain perfusion index in a porcine model.  I could use some help in finding more articles like these, or articles from anesthesia literature, that link brain function to ETCO2   I would also be interested in unpublished case reports.

Why is this important?  We need to be able to recognize this phenomenon so we can provide appropriate pain relieve and/or sedation so we can perform good cardiac care.  If these patients are even partially aware of what is happening around them, we need to modify our behavior, particularly what we are saying.  While protocols are available for pain relief and sedation, we (emergency healthcare) have not yet grappled with the eithical (and possibly legal) issues of ceasing resuscitation of a patient who has awareness.  Then there are family issues to consider, for example how long do we confinue CPR so family can say good-bye?  And there are the emotional impact on the providers must be considered.

Do you have articles, case reports, and/or protocols related to CPR Induced Consciousness that you would like to share?  Please send me a message via e-mail (hugh@emergencycapnography.com) or through the "Contact Me" form on my website.  Thank you!