Awareness During Resuscitation - II: A Multi-Center Study of Consciousness and Awareness in Cardiac Arrest

19 Pages Posted: 11 Jan 2023

See all articles by sam parnia

sam parnia

New York University Medical Center - Division of Pulmonary, Critical Care and Sleep Medicine

Tara Keshavarz Shirazi

New York University (NYU) - Grossman School of Medicine

Jignesh K. Patel

Stony Brook University

Linh Tran

Stony Brook University

Niraj Sinha

Stony Brook University

O'Neill Caitlin

New York University (NYU) - Grossman School of Medicine

Emma Roellke

New York University (NYU) - Grossman School of Medicine

Amanda Mengotto

New York University (NYU) - Grossman School of Medicine

Shannon Findlay

University of Iowa - University of Iowa Hospitals & Clinics

Michael McBrine

Tufts University - School of Medicine

Rebecca Spiegel

Stony Brook University

Thaddeus Tarpey

New York University Medical Center - Division of Pulmonary, Critical Care and Sleep Medicine

Elise Huppert

New York University (NYU) - Grossman School of Medicine

Ian S. Jaffe

New York University Medical Center - Division of Pulmonary, Critical Care and Sleep Medicine

Anelly M. Gonzales

New York University Medical Center - Division of Pulmonary, Critical Care and Sleep Medicine

Jing Xu

New York University (NYU) - Grossman School of Medicine

Emmeline Koopman

New York University (NYU) - Grossman School of Medicine

Gavin D. Perkins

University of Warwick

Alain Vuylsteke

NHS Foundation Trust - Royal Papworth Hospital

Ben Bloom

Bart's Health NHS Trust - The Royal London Hospital

Heather Jarman

St George’s University Hospitals NHS Foundation Trust

Hiu Nam Tong

The Queen Elizabeth Hospital

Louisa Chan

Hampshire Hospitals NHS Foundation Trust

Lyaker Michael

Ohio State University (OSU) - Wexner Medical Center

Matthew Thomas

University Hospitals Bristol - University Hospitals Bristol and Weston NHS Foundation Trust

Veselin Velchev

St. Anna University Hospital

Charles Cairns

Drexel University College of Medicine

Rahul Sharma

Cornell University - Weill Cornell Medicine

Erik Kulstad

University of Texas at Dallas - Southwestern Medical Center

Elizabeth Schrerer

UT Health San Antonio

Terence O'Keeffe

Augusta University Medical Center

Mahtab Foroozesh

Virginia Tech - Virginia Tech Carilion School of Medicine

Olumayowa Abe

NewYork-Presbyterian Hospital

Chinwe Ogedegbe

Hackensack Meridian Health

Amira Girgis

Kingston Hospital NHS Foundation Trust

Deepak Pradhan

New York University Medical Center - Division of Pulmonary, Critical Care and Sleep Medicine

Charles Deakin

University of Southampton - University Hospital Southampton NHS Foundation Trust

Abstract

Aim: Cognitive activity and awareness during cardiac arrest (CA) are reported but ill understood. This first of a kind study examined consciousness and its underlying electrocortical biomarkers during cardiopulmonary resuscitation (CPR).

Methods: In a prospective 25-site in-hospital study, we incorporated a) independent audiovisual testing of awareness, including explicit and implicit learning using a computer and headphones, with b) continuous real-time electroencephalography(EEG) and cerebral oxygenation(rSO2) monitoring into CPR during in-hospital CA (IHCA). Survivors underwent interviews to examine for recall of awareness and cognitive experiences. A complementary cross-sectional community CA study provided added insights regarding survivors’ experiences.

Results: Of 567 IHCA, 53(9.3%) survived, 28 of these (52.8%) completed interviews, and 11(39.3%) reported CA memories/perceptions suggestive of consciousness. Four categories of experiences emerged: 1) emergence from coma during CPR (CPR-induced consciousness [CPRIC]) 2/28(7.1%), or 2) in the post-resuscitation period 2/28(7.1%), 3) dream-like experiences 3/28(10.7%), 4) transcendent recalled experience of death (RED) 6/28(21.4%). In the cross-sectional arm, 126 community CA survivors’ experiences reinforced these categories and identified another: delusions (misattribution of medical events). Low survival limited the ability to examine for implicit learning. Nobody identified the visual image, 1/28(3.5%) identified the auditory stimulus. Despite marked cerebral ischemia (Mean rSO2=43%) normal EEG activity (delta, theta and alpha) consistent with consciousness emerged as long as 35-60 minutes into CPR.

Conclusions: Consciousness and awareness may occur during CA. The emergence of normal EEG may reflect a resumption of a network-level of cognitive activity, and a biomarker of consciousness, lucidity and RED (authentic 'near-death' experiences).

Note: Funding Information: The John Templeton Foundation, Resuscitation Council (UK), New York University Medical Center, Department of Medicine. In addition, the National Institutes for Health Research (NIHR) in the UK provided assistance with research support staff across the UK.

Conflict of Interests: None of the authors have any conflicts of interest to declare except Dr. Erik Kulstad. Dr. Kulstad reports grants from New York University Langone Health (NYULH) Department of Medicine, as well as The John Templeton Foundation as a sub-contact from the University of California at Riverside and by the Resuscitation Council (United Kingdom), as well as a, separate grant from the John Templeton Foundation. Service support has also come from the National Institute for Health Research (NIHR) in the UK, during the conduct of the study; grants from NHLBI - Grant Number: 1 R44 HL158375-01 - Utility of Esophageal Cooling Therapy for the Prevention of Thermal Injury During Atrial Fibrillation Ablation, personal fees from Attune Medical, outside the submitted work; In addition, Dr. Kulstad has a patent Devices and Methods for Controlling Patient Temperature - Patent family, including 8,231,664, 8,444,684, 8,523929, 9,326,890, 10,363,162, etc. issued.

Ethical Approval: The protocol received ethics committee approval from all sites prior to enrolling the first participant at each site. Written informed consent was obtained from survivors; a waiver was approved to use data from non-survivors.

Keywords: Cardiac Arrest, Cardiopulmonary Resuscitation (CPR), Consciousness, Recalled Experience of Death (RED), Near-Death Experiences (NDE)

Suggested Citation

parnia, sam and Keshavarz Shirazi, Tara and Patel, Jignesh K. and Tran, Linh and Sinha, Niraj and Caitlin, O'Neill and Roellke, Emma and Mengotto, Amanda and Findlay, Shannon and McBrine, Michael and Spiegel, Rebecca and Tarpey, Thaddeus and Huppert, Elise and Jaffe, Ian S. and Gonzales, Anelly M. and Xu, Jing and Koopman, Emmeline and Perkins, Gavin D. and Vuylsteke, Alain and Bloom, Ben and Jarman, Heather and Nam Tong, Hiu and Chan, Louisa and Michael, Lyaker and Thomas, Matthew and Velchev, Veselin and Cairns, Charles and Sharma, Rahul and Kulstad, Erik and Schrerer, Elizabeth and O'Keeffe, Terence and Foroozesh, Mahtab and Abe, Olumayowa and Ogedegbe, Chinwe and Girgis, Amira and Pradhan, Deepak and Deakin, Charles, Awareness During Resuscitation - II: A Multi-Center Study of Consciousness and Awareness in Cardiac Arrest. Available at SSRN: https://ssrn.com/abstract=4246760 or http://dx.doi.org/10.2139/ssrn.4246760

Sam Parnia (Contact Author)

New York University Medical Center - Division of Pulmonary, Critical Care and Sleep Medicine ( email )

Tara Keshavarz Shirazi

New York University (NYU) - Grossman School of Medicine ( email )

New York, NY
United States

Jignesh K. Patel

Stony Brook University ( email )

Linh Tran

Stony Brook University ( email )

Niraj Sinha

Stony Brook University ( email )

O'Neill Caitlin

New York University (NYU) - Grossman School of Medicine ( email )

New York, NY
United States

Emma Roellke

New York University (NYU) - Grossman School of Medicine ( email )

New York, NY
United States

Amanda Mengotto

New York University (NYU) - Grossman School of Medicine ( email )

New York, NY
United States

Shannon Findlay

University of Iowa - University of Iowa Hospitals & Clinics ( email )

Michael McBrine

Tufts University - School of Medicine ( email )

Rebecca Spiegel

Stony Brook University ( email )

Thaddeus Tarpey

New York University Medical Center - Division of Pulmonary, Critical Care and Sleep Medicine ( email )

Elise Huppert

New York University (NYU) - Grossman School of Medicine ( email )

New York, NY
United States

Ian S. Jaffe

New York University Medical Center - Division of Pulmonary, Critical Care and Sleep Medicine ( email )

Anelly M. Gonzales

New York University Medical Center - Division of Pulmonary, Critical Care and Sleep Medicine ( email )

Jing Xu

New York University (NYU) - Grossman School of Medicine ( email )

New York, NY
United States

Emmeline Koopman

New York University (NYU) - Grossman School of Medicine ( email )

Gavin D. Perkins

University of Warwick ( email )

Alain Vuylsteke

NHS Foundation Trust - Royal Papworth Hospital ( email )

Ben Bloom

Bart's Health NHS Trust - The Royal London Hospital ( email )

Whitechapel Road
London, E1 1BB
United Kingdom

Heather Jarman

St George’s University Hospitals NHS Foundation Trust ( email )

Hiu Nam Tong

The Queen Elizabeth Hospital ( email )

Louisa Chan

Hampshire Hospitals NHS Foundation Trust ( email )

Hampshire
United Kingdom

Lyaker Michael

Ohio State University (OSU) - Wexner Medical Center ( email )

Matthew Thomas

University Hospitals Bristol - University Hospitals Bristol and Weston NHS Foundation Trust ( email )

Bristol
United Kingdom

Veselin Velchev

St. Anna University Hospital ( email )

Charles Cairns

Drexel University College of Medicine ( email )

PA
United States

Rahul Sharma

Cornell University - Weill Cornell Medicine ( email )

New York, NY
United States

Erik Kulstad

University of Texas at Dallas - Southwestern Medical Center ( email )

Dallas, Texas, TX
United States

Elizabeth Schrerer

UT Health San Antonio ( email )

Terence O'Keeffe

Augusta University Medical Center ( email )

Mahtab Foroozesh

Virginia Tech - Virginia Tech Carilion School of Medicine ( email )

Roanoke, 24016
United States

Olumayowa Abe

NewYork-Presbyterian Hospital ( email )

Chinwe Ogedegbe

Hackensack Meridian Health ( email )

Amira Girgis

Kingston Hospital NHS Foundation Trust ( email )

Deepak Pradhan

New York University Medical Center - Division of Pulmonary, Critical Care and Sleep Medicine ( email )

Charles Deakin

University of Southampton - University Hospital Southampton NHS Foundation Trust ( email )

University Rd.
Southampton SO17 1BJ, SO17 1LP
United Kingdom

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