Pre-hospital guidelines for CPR-Induced Consciousness (CPRIC): A scoping review

Jack Howard; Carlos Lipscombe; Bronwyn Beovich; Matthew Shepherd; Eystein Grusd; Nikiah G Nudell; Don Rice; Alexander Olaussen

doi:10.1016/j.resplu.2022.100335

Pre-hospital guidelines for CPR-Induced Consciousness (CPRIC): A scoping review

Resusc Plus. 2022 Nov 28:12:100335. doi: 10.1016/j.resplu.2022.100335. eCollection 2022 Dec.

Authors

Jack Howard^{1

2}, Carlos Lipscombe¹, Bronwyn Beovich¹, Matthew Shepherd^{1

2}, Eystein Grusd³, Nikiah G Nudell^{4

5}, Don Rice⁶, Alexander Olaussen^{1

7

8}

Affiliations

¹ Department of Paramedicine, Monash University, Melbourne, Australia.
² Ambulance Victoria, Melbourne, Victoria, Australia.
³ Department of Health Sciences Gjøvik, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Gjøvik, Norway.
⁴ Trauma Research Department, Medical Center of the Rockies, UCHealth, Loveland, CO, USA.
⁵ The Paramedic Foundation, Duluth, MN, USA.
⁶ University of Nebraska Medical Center, Omaha, NE, USA.
⁷ National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia.
⁸ Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia.

Abstract

Background: CPR-Induced Consciousness is an emerging phenomenon with a paucity of consensus guidelines from peak resuscitative bodies. Local prehospital services have had to implement their own CPR-Induced Consciousness guidelines. This scoping review aims to identify prehospital CPR-Induced Consciousness guidelines and compare or contrast their management options.

Objective: The purpose of this scoping review is to identify and compare as many prehospital CPR-Induced Consciousness guidelines as feasible, highlight common management trends, and discuss the factors that might impact CPR-Induced Consciousness guidelines and the management trends identified.

Design: To search for prehospital CPR-Induced Consciousness guidelines, a bibliographical search of five databases was undertaken (MEDLINE, EMBASE, Cochrane, Scopus, and CINAHL plus). Also included was a grey literature search arm, comprised of four search strategies: 1. Customised Google search, 2. Hand searching of targeted websites, 3. Grey literature databases, 4. Consultation with subject experts.

Results: Our search extracted 23 prehospital CPR-Induced Consciousness guidelines and one good practise statement from the International Liaison Committee on Resuscitation. Of the 23 prehospital guidelines available, we identified 20 different ways of treating CPR-Induced Consciousness. Midazolam was the most frequently used drug to treat CPR-Induced Consciousness (14/23, 61%), followed by Ketamine (11/23, 48%) and Fentanyl (9/23, 39%).

Conclusion: Prehospital CPR-Induced Consciousness guidelines are both exceptionally uncommon and vary substantially from each other. This has a flow-on effect towards data collection and only serves to continue CPR-Induced Consciousness's relatively unknown status surrounding both knowledge of, and the effect CPR-Induced Consciousness treatment has on cardiac arrest outcomes.

Keywords: Awareness; CPR-induced consciousness; CPRIC; Cardiopulmonary Resuscitation; Consciousness; Emergency medical services; Heart arrest; Paramedic; Prehospital; Resuscitation.

Publication types

Review