CPR-Induced Conciousness

Sounds great right? CPR is suppose to induce consciousness! In this case, however, it refers to something a bit more morbid.

With the emergence of programs calling for higher quality CPR and the recent introduction of mechanical CPR devices (Lucas Device) to EMS and hospitals, health care has seen a rise of the phenomenon of CPR-induced consciousness.  This event occurs when the heart is in cardiac arrest, but the CPR being preformed is so good that the brain is receiving enough oxygen and nutrients to regain a state of consciousness. This requires a great amount of high quality compression and high levels of oxygenation for an individual. This consciousness comes in two ways, high or low level of consciousness.  Some cases reported found patients only respond to pain and make non-purposeful body movements with no eye response (Glasgow Coma Score score below 8).  In a study by Olaussen et. al., they found that 57 of the 67 providers surveyed had experienced this low level of consciousness an average of 3 times in their mean of 11 years of practice.  In the case of high levels of consciousness, patients are seen to have spontaneous eye movement, purposeful body movement and appear alert (Glasgow Coma Score score above 8).  This consciousness, however, ceases if CPR is stopped, and a cardiac monitor shows these patients still in cardiac arrest.  For these patients, their body is working because of our artificial heart stimulation.

CPR-induced consciousness brings up several issues of ethics.  First, when the person is awake but their heart is not beating, what is the ethical or humane thing for a provider to do?  Being awake and having a person pushing (very hard) on your chest has the potential to be incredibly painful.  This pain would be unbearable for a fully conscious person, so is it ethical to continue CPR on the conscious party? On the other hand, if you stop CPR, you know the person will not stay conscious for long, and you will be putting them back in their "dead" state once again.

A second question of ethics has to do with when we define death.  There is potential that after 15 minutes of CPR, an individual, that if not sedated would be conscious, could be in an asystolic rhythm and unable to recover from it.  Is it ethical to stop CPR on this person knowing fully well that they are still "alive" (with the capacity for consciousness) but would customarily be deemed clinically deceased?  This idea of pronouncing someone dead who is sedated by medical means, but would be conscious otherwise is something that needs to be considered by the medical community.

As medicine progresses and our skills get better, we find ourselves in new ethical predicaments.  Medical providers hold the power to decide whether you live or die every day, they hold the power to decide when your time has come or when you get to fight.  These are incredibly powerful things that need to be a the forefront of providers minds when they are dealing with the life and death of their patients.