Priority 1 – CPR Induced Consciousness

In some patients, the application of CPR, particularly when using mCPR (mechanical CPR), may produce sufficient cerebral perfusion for signs of consciousness in the absence of ROSC.

Patients may display a variety of signs, including:

• Eye opening
• Increased jaw tone
• Incomprehensible sounds
• Recognisable words or speech
• Limb movement
• Purposeful movements, e.g. localising to pain
• Combative movements, e.g. pushing rescuers away

Key Points for CPR-Induced Consciousness

Even if a patient is displaying any of these features, ad hoc rhythm checks are not recommended and paramedics should limit rhythm checks to once every 2 minutes, as per conventional guidance.

CPR-induced consciousness (CPR-IC) should be recognised at the earliest opportunity. Signs that may help paramedics distinguish CPR-IC from ROSC may include:

• An absence of palpable pulses
• A rapid deterioration in consciousness when chest compressions are stopped
• A cardiac rhythm considered incompatible with life
• In patients with symptoms that create difficulty in delivering high-quality CPR, or when the patient may be distressed, paramedics may wish to consider requesting enhanced care support or advice as per local procedures/pathways or rapid conveyance to hospital to facilitate ongoing treatment