Prehospital practitioner awareness and experience of CPR-induced consciousness

Background:
Cardiopulmonary resuscitation-induced consciousness (CPRIC) is an important but under-researched area. CPRIC in Irish emergency services has never been examined and this study aimed to explore the experiences of prehospital practitioners.
Methods:
This study includes qualitative and quantitative elements, using an online anonymous survey followed by a confidential, one-to-one, semi-structured interview with emergency medical technicians, paramedics and advanced paramedics.
Results:
Of the respondents surveyed, 93% had been involved in the care of at least one case of out-of-hospital cardiac arrest (OHCA); 36% had managed 6–10 OHCAs within the previous 12 months. Three-quarters (75%) were aware of CPRIC and 57% reported that they had witnessed at least one episode of this. CPRIC incidents were characterised by a range of clinical features, which sometimes interrupted care provision and were managed using wide-ranging and non-standardised responses including drug therapy. Both high-quality manual and mechanical CPR were linked to CPRIC. The rate of reported return of spontaneous circulation (63%) was significantly higher than that in Irish national data for OHCA. Seven volunteers participated in confidential semi-structured interviews. Themes identified included the impact on resuscitation, unfamiliarity with CPRIC manifestations, how CPRIC affected practitioners and educational needs. Practitioners experienced distress because of this phenomenon. All highlighted their desire to have CPRIC addressed by clinical practice guidelines.