Author: Parnia, Sam; Keshavarz 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.; Sharma, Rahul; Kulstad, Erik; Scherer, Elizabeth; O’Keeffe, Terence; Foroozesh, Mahtab; Abe, Olumayowa; Ogedegbe, Chinwe; Girgis, Amira; Pradhan, Deepak; Deakin, Charles D.
Description: 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).
Subject headings: Humans; Consciousness; Cardiopulmonary Resuscitation; Prospective Studies; Cross-Sectional Studies; Heart Arrest; Death; Biomarkers; Out-of-Hospital Cardiac Arrest; Cardiac arrest; Cardiopulmonary Resuscitation (CPR); Consciousness; Near-Death Experiences (NDE); Recalled Experience of Death (RED)
Publication year: 2023
Journal or book title: Resuscitation
Volume: 191
Pages: 109903
Find the full text: https://www.resuscitationjournal.com/action/showPdf?pii=S0300-9572%2823%2900216-2
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Serial number: 3876