Cardiopulmonary Resuscitation Induced Consciousness in Asystolic Cardiac Arrest: A Case Report from Vinmec Smart City Hospital, Vietnam
Nguyen Cong Hoa *
Department of Emergency Medicine, Vinmec Smart City International Hospital, Hanoi, Vietnam.
Do Hong Cong
Department of Emergency Medicine, Vinmec Smart City International Hospital, Hanoi, Vietnam.
Nguyen Thi Hong Diep
Department of Emergency Medicine, Vinmec Smart City International Hospital, Hanoi, Vietnam.
*Author to whom correspondence should be addressed.
Abstract
Background: Cardiopulmonary resuscitation–induced consciousness (CPRIC) refers to the presence of awareness, motor activity, or purposeful movements during ongoing chest compressions in the absence of return of spontaneous circulation (ROSC). Its reported incidence ranges from 0.3–0.9% of cardiac arrests, and it is typically observed in shockable rhythms such as ventricular fibrillation. Occurrence in asystole is exceedingly rare and poses challenges for both recognition and management.
Case Report: We describe a 62-year-old woman with a history of benign vertigo but no cardiovascular risk factors who suddenly collapsed at home. She was resuscitated at a local health post with 1 mg adrenaline and chest compressions before being transferred by emergency medical services (EMS) to Vinmec Smart City International Hospital. On arrival, she remained in asystole after approximately 20 minutes of no-flow/low-flow time. High-quality advanced life support was initiated and continued for 60 minutes. Despite persistent asystole on ECG, the patient exhibited repeated upper limb movements during chest compressions, raising suspicion for CPRIC. No eye opening or verbal response occurred. More than 10 doses of adrenaline were administered, with transient EtCO₂ elevations up to 25 mmHg and oxygen saturations between 98–100%. Bedside ultrasound and point-of-care laboratory tests revealed no reversible cause of arrest. Although extracorporeal cardiopulmonary resuscitation (ECPR) was considered, it was not initiated given the asystolic rhythm, prolonged arrest, and family decision. Resuscitation was ultimately terminated without ROSC.
Conclusion: This case highlights CPRIC in asystolic cardiac arrest, an uncommon presentation that may mislead resuscitation teams. Awareness of CPRIC is crucial to prevent inappropriate termination of compressions and to guide decisions regarding sedation or ECPR in selected patients. This report contributes to the limited literature on CPRIC in non-shockable rhythms.
Keywords: CPR-induced consciousness, cardiac arrest, asystole, cardiopulmonary resuscitation, extracorporeal life support