Cardiopulmonary resuscitation-induced consciousness in an elderly patient: a case report in the prehospital setting

Cardiopulmonary resuscitation (CPR) aims to limit hypoxic injury by providing oxygen to brain and heart tissues during cardiac arrest. There has been an increase in reports of patients exhibiting signs such as eye opening, limb movement, agitation, or even interference with resuscitation maneuvers while receiving CPR. These manifestations cease when chest compressions are stopped, even without achieving return of spontaneous circulation (ROSC). This phenomenon is termed CPR-induced consciousness (CPRIC). CPRIC cases are typically associated with cardiac arrest of cardiac origin, shockable rhythms, and witnessed arrests with timely CPR. Here, we present the case of an 80-year-old man who collapsed in a public setting. During resuscitation by Bystanders, the patient showed purposeful movements and vocalizations, leading to incorrect interruptions of compressions due to presumed ROSC. Once CPRIC was recognized, chest compressions and defibrillation continued, achieving ROSC. This case highlights the importance of training prehospital providers to recognize and manage CPRIC, including the potential use of sedatives—such as ketamine—to control movements that interfere with resuscitation. The case also underscores the need for effective communication strategies with bystanders, given the social and ethical implications of CPRIC manifestations. Further research is necessary to establish clear international guidelines and improve clinical outcomes for patients experiencing CPRIC.