Introduction and Purpose: CardioPulmonary Resuscitation Induced Consciousness (CPRIC) can have a severe psychological impact on the patient, but also on the professionals.1,2 We noted increasing caregiver’s reports on CPRIC, including hints of avoidance, stress reactions and professional dysfunction.2,3 CPRIC was associated with repetitive interruption of compressions, decreased compression depth, and their feeling of offering substandard care. Suggestions for pain- sedation management include opioids,4 benzodiazepam and ketamine.1,5 We assessed frequency and severity of CPRIC induced psychological impact for caregivers as well as their interventions if CRPIC occurred.

Materials and methods: We approached ANE, ED, ICU physicians in our 950-bed hospital system with an anonymous questionnaire. It focused on the caregivers: their experience, perceptions and remediations. Questionnaire available via: j.versteeg@etz.nl

Results:  71 questionnaires (86%) were returned.  48% reported multiple experiences with CPRIC and >90% reported (detrimental) effects on treatment and team-members. While 52% reported personal discomfort, 7% reported sleeplessness, nightmares, mood changes, extending up to weeks. 
All exposed reported frustration in remediation.  Most use Midazolam (45x), 11x ketamine, with only 4x using opioids alone,4. Combinations with diprivan, etomidate and ketamine were reported. All worry about medication induced negative effects on circulation and lack of evidence for dose-effects relationships.

Conclusions: We recommend that CPRIC procedures in guidelines, as well as focused, psychologic, attention strategies for exposed caregivers. Teams perceive an inability to effectively help without ‘causing further harm’. CPRIC should receive attention as improved resuscitation will further increase incidence and for its impact on patients and caregivers. Pharmacologically, ketamine-midazolam seem logical choices in CPRIC, targeting analgesia and antegrade amnesia, with less vascular resistance loss. 


References:
1.	Rice DT, et al. Resuscitation 2016;103:e15-e16.
2.	Olaussen A, et al. Resuscitation 2015;86:44-8.
3.	Krage R, et al. Emerg Med J 2017;34(11):728-33.
4.	In’t Veld, et al., Landelijk Protocol Ambulancezorg, Zwolle (NL), 2014.
5.	Olaussen A et al. Resuscitation 2017;113:44-50.

8 - CPR-Induced Consciousness: attention required for caregivers and medication