Awake, But Not Beating: A Case Of CPR-Induced Consciousness Documented With Point-Of-Care Ultrasound In The Emergency Department

Romulo Iii Babasa, Reiser Ruiz-Pickmans


We report a case of a 65 year-old female, with no known co-morbidities who presented to the Emergency Department with inferior wall ST-elevation myocardial infarction.

After providing initial pharmacologic management, patient was advised percutaneous coronary intervention (PCI) but opted to be transferred to another hospital.

While being endorsed to the transferring ambulance team, patient suddenly complained of dyspnea, developed ventricular fibrillation and became unresponsive.

She was immediately given cardiopulmonary resuscitation (CPR) and received multiple defibrillation attempts.

During active chest compressions, the patient exhibited purposeful and resistive movements comprised of grasping hands of team members at the bedside and actively shoving the bag-valve mask off her face.

During pulse checks, wherein point-of-care ultrasound (POCUS) revealed asystole, these resistive movements stopped and the patient remained motionless. Patient was given Midazolam per IV to attenuate the disruptive effects of these movements during CPR.

Return of spontaneous circulation was eventually achieved and the patient was successfully transferred to hospital of choice where she underwent PCI.

This is the first documented case report of CPR-induced consciousness wherein effective cardiac compressions and asystole were guided by POCUS.

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