Cardiac Arrest Patients Exhibiting Awareness During Resuscitation: A Systematic Review of CPR-Induced Consciousness (CPRIC) in Adults

Esmaeilnezhad, Ghodsieh; Hajiaghaei, Sana; Ramezani, Mir Saeid

doi:10.22088/caspjs.2026.2084520.1050

Cardiac Arrest Patients Exhibiting Awareness During Resuscitation: A Systematic Review of CPR-Induced Consciousness (CPRIC) in Adults

Document Type : Review Article

Authors

Ghodsieh Esmaeilnezhad

Sana Hajiaghaei

Mir Saeid Ramezani

Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran

10.22088/caspjs.2026.2084520.1050

Abstract

Background: CPR-induced consciousness (CPRIC) is a phenomenon where patients regain cerebral perfusion sufficient to exhibit signs of life during active resuscitation. While documented in medical cardiac arrest, its prevalence and management in traumatic cardiac arrest (TCA) remain poorly defined.
Objectives: To systematically review the manifestations, management, and outcomes of CPRIC in adult patients following traumatic cardiac arrest.
Methods: A PRISMA-compliant systematic review was conducted across PubMed, Scopus, Web of Science, and Cochrane Library from inception to January 2026. Studies involving adult TCA patients exhibiting CPRIC were included.
Results: Eleven studies (case reports and small case series) met inclusion criteria, representing 14 unique cases. Manifestations ranged from purposeful limb movement and eye-opening to combativeness and verbalization. Interventions often involved the ad-hoc administration of ketamine or benzodiazepines. Survival to discharge was higher in this subgroup than general TCA cohorts, though heterogeneity was high.
Conclusion: CPRIC in trauma presents unique clinical and ethical challenges. Standardized protocols for sedation during TCA are urgently required to prevent patient distress and provider interference.

Keywords

cardiopulmonary resuscitation

Consciousness

management

Subjects