AWAreness during REsuscitation - II: A multi-center study of consciousness and awareness in cardiac arrest.

Autor: Parnia S; Critical Care and Resuscitation Research Program, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA. Electronic address: sam.parnia@nyulangone.org., Keshavarz Shirazi T; Critical Care and Resuscitation Research Program, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA., Patel J; Division of Pulmonary, Critical Care and Sleep Medicine, Stony Brook University Hospital, Long Island, NY, USA., Tran L; Division of Pulmonary, Critical Care and Sleep Medicine, Stony Brook University Hospital, Long Island, NY, USA., Sinha N; Division of Pulmonary, Critical Care and Sleep Medicine, Stony Brook University Hospital, Long Island, NY, USA., O'Neill C; Critical Care and Resuscitation Research Program, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA., Roellke E; Critical Care and Resuscitation Research Program, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA., Mengotto A; Critical Care and Resuscitation Research Program, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA., Findlay S; Department of Emergency Medicine, University of Iowa Hospital, Iowa, USA., McBrine M; Department of Pulmonary, Critical Care and Sleep Medicine, Tufts University School of Medicine, MA, USA., Spiegel R; Stony Brook Level 4 Epilepsy Center at the School of Medicine Stony Brook University, Long Island, NY, USA., Tarpey T; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA., Huppert E; Critical Care and Resuscitation Research Program, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA., Jaffe I; Critical Care and Resuscitation Research Program, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA., Gonzales AM; Critical Care and Resuscitation Research Program, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA., Xu J; Critical Care and Resuscitation Research Program, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA., Koopman E; Critical Care and Resuscitation Research Program, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA., Perkins GD; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Critical Care Unit, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK., Vuylsteke A; Department of Surgery, Transplant and Anaesthetics, Royal Papworth Hospital NHS Foudnation Trust, Cambridge, UK., Bloom BM; Department of Emergency Medicine, Royal London Hospital, Barts Health NHS Trust, London, UK; Department of Emergency Medicine, Whipps Cross Hospital, Barts Health NHS Trust, London, UK; Department of Emergency Medicine, Newham Hospital, Barts Health NHS Trust, London, UK., Jarman H; Emergency Department, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK., Nam Tong H; Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK., Chan L; Department of Emergency Medicine and Department of Intensive Care, Hampshire Hospitals NHS Foundation Trust, Hampshire, UK., Lyaker M; Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH, USA., Thomas M; Department of Critical Care Medicine, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK., Velchev V; Department of Anesthesiology and Intensive Care, St. Anna University Hospital, Sofia, Bulgaria., Cairns CB; Department of Medicine and Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA, USA., Sharma R; Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA., Kulstad E; Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, USA., Scherer E; Division of Trauma and Emergency Surgery, Department of Surgery, UT Health San Antonio, San Antonio, TX, USA., O'Keeffe T; Division of Trauma/Surgical Critical Care/General Surgery, Department of Surgery, Augusta University Medical Center, Augusta, GA, USA., Foroozesh M; Pulmonary, Critical Care Medicine and Sleep Medicine Section, Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA., Abe O; Division of Critical Care Medicine, NewYork-Presbyterian Queens Hospital, New York, NY, USA., Ogedegbe C; Department of Emergency Medicine, Hackensack Meridian School of Medicine, Nutley, NJ, USA., Girgis A; Department of Anesthetics and Acute Pain, Kingston Hospital NHS Foundation Trust, Surrey, UK., Pradhan D; Critical Care and Resuscitation Research Program, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA., Deakin CD; University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
Jazyk: angličtina
Zdroj: Resuscitation [Resuscitation] 2023 Oct; Vol. 191, pp. 109903. Date of Electronic Publication: 2023 Jul 07.
DOI: 10.1016/j.resuscitation.2023.109903
Abstrakt: 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(rSO 2 ) 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 rSO 2  = 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).
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023. Published by Elsevier B.V.)
Databáze: MEDLINE
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