AWAreness during REsuscitation - II: A multi-center study of consciousness and awareness in cardiac arrest.
Sam Parnia, Tara Keshavarz Shirazi, Jignesh Patel, Linh Tran, Niraj Sinha, Caitlin O'Neill, Emma Roellke, Amanda Mengotto, Shannon Findlay, Michael Mcbrine, Rebecca Spiegel, Thaddeus Tarpey, Elise Huppert, Ian Jaffe, Anelly M Gonzales, Jing Xu, Emmeline Koopman, Gavin D Perkins, Alain Vuylsteke, Benjamin M Bloom, Heather Jarman, Hiu Nam Tong, Louisa Chan, Michael Lyaker, Matthew Thomas, Veselin Velchev, Charles B Cairns, Rahul Sharma, Erik Kulstad, Elizabeth Scherer, Terence O'Keeffe, Mahtab Foroozesh, Olumayowa Abe, Chinwe Ogedegbe, Amira Girgis, Deepak Pradhan, Charles D Deakin
Resuscitation October 1, 2023 DOI: 10.1016/j.resuscitation.2023.109903 via PubMed
Summary
AI-generated from the abstractDuring cardiac arrest and cardiopulmonary resuscitation (CPR), some patients show signs of consciousness and cognitive activity, including brain activity on EEG that resembles normal waking patterns despite severe oxygen deprivation. In a study of 567 in-hospital cardiac arrests, 11 of 28 survivors interviewed reported memories or perceptions suggesting consciousness during CPR. Four categories of experiences emerged: CPR-induced consciousness, post-resuscitation awareness, dream-like experiences, and transcendent recalled experience of death (RED). A separate group of 126 community survivors reinforced these categories and added delusions. Normal EEG activity (delta, theta, alpha) appeared for up to 35–60 minutes into CPR even with low cerebral oxygenation, suggesting that a network-level cognitive activity and lucidity may occur during cardiac arrest.
Study at a glance
| Characteristics | Prospective observational study with cross-sectional community arm Peer reviewed |
|---|---|
| Sample size | 567 |
| Population | Adults with in-hospital cardiac arrest (IHCA) and community cardiac arrest survivors |
| Keywords | Cardiac arrest Cardiopulmonary resuscitation cpr Consciousness Near-death experiences nde |
| Citations | 64 |
| Key finding | Consciousness, awareness, and cognitive processes may occur during cardiac arrest, with normal EEG activity emerging despite severe cerebral ischemia, and survivors report distinct categories of experiences including transcendent recalled experience of death. |
Abstract
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). 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. 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. 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).