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CPR-induced consciousness (CPR-IC) out-of-hospital care: a scoping review protocol

02 May 2023
Volume 13 · Issue 2



Cardiopulmonary resuscitation-induced consciousness (CPR-IC) is an increasing phenomenon where patients in cardiac arrest receive sufficient brain perfusion to display signs of awareness during resuscitation. This is likely due to improvements in CPR, such as high-performance resuscitation and mechanical devices. CPR-IC has been shown to interfere with rescue efforts and may lead to psychological trauma in both patients and clinicians. It is often witnessed in the out-of-hospital environment, so is significant for practitioners working in this setting. While the phenomenon of CPR-IC has been recognised for several decades, there are many gaps in the literature and no consensus has been reached over its definition or management.


The JBI scoping review methodology will be used to map the existing literature and identify the extent of clinical knowledge and any gaps regarding the management of CPR-IC in out-of-hospital cardiac arrest globally. A comprehensive electronic search strategy will be employed to source works that meet to the study’s inclusion criteria. Relevant data will then be extracted and presented in tabular form with narrative descriptions.


CPR-IC is being seen more frequently and, because of its effects on resuscitation, more knowledge is required about appropriate management. This protocol provides the framework for a scoping review which will outline the extent of knowledge and identify areas requiring more research regarding out-of-hospital care of the patient with CPR-IC.

In cardiac arrest, the primary interventions used to regain spontaneous circulation are cardiopulmonary resuscitation (CPR), defibrillation and pharmacological agents such as adrenaline. Recent years have seen a greater emphasis on high-performance CPR, which is likely to be responsible for the increasing rate of CPR-induced consciousness (CPR-IC) (Pound et al, 2017). CPR-IC is a poorly understood phenomenon where patients regain consciousness and pain perception during CPR without return of spontaneous circulation (ROSC) (Pourmand et al, 2019).

Although CPR-IC has been discussed in the literature for upwards of 30 years, an agreed definition of it does not exist (Carty and Bury, 2022). In pulseless patients undergoing CPR, CPR-IC has been described as one or more of spontaneous speech, body movement, recovery of jaw tone or eye-opening, which lapse on cessation of CPR (Olaussen et al, 2015).

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