TY - JOUR
T1 - AWAreness during REsuscitation - II
T2 - A multi-center study of consciousness and awareness in cardiac arrest
AU - Parnia, Sam
AU - Keshavarz Shirazi, Tara
AU - Patel, Jignesh
AU - Tran, Linh
AU - Sinha, Niraj
AU - O'Neill, Caitlin
AU - Roellke, Emma
AU - Mengotto, Amanda
AU - Findlay, Shannon
AU - McBrine, Michael
AU - Spiegel, Rebecca
AU - Tarpey, Thaddeus
AU - Huppert, Elise
AU - Jaffe, Ian
AU - Gonzales, Anelly M.
AU - Xu, Jing
AU - Koopman, Emmeline
AU - Perkins, Gavin D.
AU - Vuylsteke, Alain
AU - Bloom, Benjamin M.
AU - Jarman, Heather
AU - Nam Tong, Hiu
AU - Chan, Louisa
AU - Lyaker, Michael
AU - Thomas, Matthew
AU - Velchev, Veselin
AU - Cairns, Charles B.
AU - Sharma, Rahul
AU - Kulstad, Erik
AU - Scherer, Elizabeth
AU - O'Keeffe, Terence
AU - Foroozesh, Mahtab
AU - Abe, Olumayowa
AU - Ogedegbe, Chinwe
AU - Girgis, Amira
AU - Pradhan, Deepak
AU - Deakin, Charles D.
N1 - Publisher Copyright: © 2023
PY - 2023/10
Y1 - 2023/10
N2 - 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).
AB - 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).
KW - Cardiac arrest
KW - Cardiopulmonary Resuscitation (CPR)
KW - Consciousness
KW - Near-Death Experiences (NDE)
KW - Recalled Experience of Death (RED)
UR - https://www.scopus.com/pages/publications/85172326122
U2 - 10.1016/j.resuscitation.2023.109903
DO - 10.1016/j.resuscitation.2023.109903
M3 - Article
C2 - 37423492
SN - 0300-9572
VL - 191
JO - Resuscitation
JF - Resuscitation
M1 - 109903
ER -