CPR-Induced Consciousness: When the "Dead" Wake Up

Alexander Olaussen
Jul 31, 2025
5 min read

By Prehospital Nerds

Imagine this: you’re delivering high-quality CPR on a patient in cardiac arrest, and suddenly—they open their eyes, start moaning, even try to push your hands away.

Welcome to the strange and confronting world of CPR-induced consciousness (CPRIC).

⚡ Key Takeaways

CPR-induced consciousness is real, rare, and can complicate resuscitation.
The incidence is rising.
There are two subtypes — interfering and non-interfering — with different management needs.
Talk to the patient — and debrief the crew.
Analgesia and sedation can help continue life-saving care.
More research and education are needed.

🔍 What Is CPR-Induced Consciousness?

CPR-induced consciousness refers to signs of awareness during ongoing chest compressions in a patient who remains in cardiac arrest — that is, with no return of spontaneous circulation (ROSC). It’s rare, under-recognised, and still poorly understood.

Patients may exhibit:

Eye opening
Groaning or vocalisations
Limb movements
Purposeful resistance to compressions

We defined two subtypes of CPRIC:

Non-interfering CPRIC: The patient shows signs of awareness but does not hinder resuscitation efforts.
Interfering CPRIC: The patient exhibits behaviours that interrupt or obstruct ongoing CPR, such as pushing rescuers away or attempting to sit up.

🧠 Where Did the Term Come From?

Over a decade ago, we were among the first to name, define, and systematically study this phenomenon. Until then, cases had been described in scattered reports, often dismissed or misunderstood.

Since our original research, the concept has gained significant traction — with formal recognition by international resuscitation councils, growing clinical awareness, and more systematic reporting worldwide.

🚑 Why It Matters in Prehospital Care

It’s confronting: For bystanders, clinicians, and family, seeing movement during CPR can cause panic, confusion, or even lead to premature cessation of efforts.
It can interrupt resuscitation: Especially with the interfering subtype, ongoing CPR can become physically difficult or impossible.
It raises ethical questions: Is the patient suffering? Are they aware? Should we treat pain or sedate them?

💉 How Should We Manage It?

There’s no single protocol, but based on current best practice and field experience, we recommend:

Recognise CPRIC early — name it, don’t freeze.
Talk to the patient — if they’re conscious enough to respond, speak calmly and clearly.
Continue CPR — unless you confirm ROSC.
Provide analgesia if there’s any suggestion of pain:– Fentanyl is commonly used– Ketamine offers analgesia plus dissociation
Sedate if interference is significant:– Midazolam at low doses may help ease agitation
Debrief the team — these cases can be psychologically jarring for clinicians too.

🔬 Research on CPR-Induced Consciousness

Our initial publications helped put CPRIC on the map. Since then, the evidence has grown significantly:

Title	Authors	Citation	Journal/Book	Publication Year	DOI
Pre-hospital guidelines for CPR-Induced Consciousness (CPRIC): A scoping review	Howard J, Lipscombe C, Beovich B, Shepherd M, Grusd E, Nudell NG, Rice D, Olaussen A.	Resusc Plus. 2022 Nov 28;12:100335. doi: 10.1016/j.resplu.2022.100335. eCollection 2022 Dec.	Resusc Plus	2022	10.1016/j.resplu.2022.100335
CPR-Induced Consciousness during Ventricular Fibrillation: Case Report and Literature Review	Zhou X, Sun B.	Emerg Med Int. 2024 Sep 28;2024:2834376. doi: 10.1155/2024/2834376. eCollection 2024.	Emerg Med Int	2024	10.1155/2024/2834376
Awareness of CPR-induced consciousness by UK paramedics	Mays B, Gregory P, Sudron C, Kilner T.	Br Paramed J. 2019 Jun 1;4(1):1-5. doi: 10.29045/14784726.2019.06.4.1.1.	Br Paramed J	2019	10.29045/14784726.2019.06.4.1.1
CPR-induced consciousness: A cross-sectional study of healthcare practitioners' experience	Olaussen A, Shepherd M, Nehme Z, Smith K, Jennings PA, Bernard S, Mitra B.	Australas Emerg Nurs J. 2016 Nov;19(4):186-190. doi: 10.1016/j.aenj.2016.07.002. Epub 2016 Jul 29.	Australas Emerg Nurs J	2016	10.1016/j.aenj.2016.07.002
AWAreness during REsuscitation - II: A multi-center study of consciousness and awareness in cardiac arrest	Parnia S, Keshavarz Shirazi T, Patel J, Tran L, Sinha N, O'Neill C, Roellke E, Mengotto A, Findlay S, McBrine M, Spiegel R, Tarpey T, Huppert E, Jaffe I, Gonzales AM, Xu J, Koopman E, Perkins GD, Vuylsteke A, Bloom BM, Jarman H, Nam Tong H, Chan L, Lyaker M, Thomas M, Velchev V, Cairns CB, Sharma R, Kulstad E, Scherer E, O'Keeffe T, Foroozesh M, Abe O, Ogedegbe C, Girgis A, Pradhan D, Deakin CD.	Resuscitation. 2023 Oct;191:109903. doi: 10.1016/j.resuscitation.2023.109903. Epub 2023 Jul 7.	Resuscitation	2023	10.1016/j.resuscitation.2023.109903
CPR-induced consciousness in hypothermic cardiac arrest: Where is the limit of tolerance of the human brain? A case report	Migiel Ł, Darocha T, Hymczak H, Podsiadło P, Mendrala K, Kosiński S.	Scand J Trauma Resusc Emerg Med. 2025 Jul 1;33(1):111. doi: 10.1186/s13049-025-01426-y.	Scand J Trauma Resusc Emerg Med	2025	10.1186/s13049-025-01426-y
CPR Induced Consciousness During Out-of-Hospital Cardiac Arrest: A Case Report on an Emerging Phenomenon	Pound J, Verbeek PR, Cheskes S.	Prehosp Emerg Care. 2017 Mar-Apr;21(2):252-256. doi: 10.1080/10903127.2016.1229823. Epub 2016 Oct 28.	Prehosp Emerg Care	2017	10.1080/10903127.2016.1229823
CPR-related cognitive activity, consciousness, awareness and recall, and its management: A scoping review	West RL, Otto Q, Drennan IR, Rudd S, Böttiger BW, Parnia S, Soar J.	Resusc Plus. 2022 May 9;10:100241. doi: 10.1016/j.resplu.2022.100241. eCollection 2022 Jun.	Resusc Plus	2022	10.1016/j.resplu.2022.100241
CPR-induced consciousness in out-of-hospital cardiac arrest patients in Western Australia: Case characteristics and CPR quality	Talikowska M, Belcher J, Ball S, Majewski D, Finn J.	Resuscitation. 2024 Aug;201:110278. doi: 10.1016/j.resuscitation.2024.110278. Epub 2024 Jun 14.	Resuscitation	2024	10.1016/j.resuscitation.2024.110278
Approach to cardiopulmonary resuscitation induced consciousness, an emergency medicine perspective	Pourmand A, Hill B, Yamane D, Kuhl E.	Am J Emerg Med. 2019 Apr;37(4):751-756. doi: 10.1016/j.ajem.2019.01.051. Epub 2019 Jan 29.	Am J Emerg Med	2019	10.1016/j.ajem.2019.01.051
CPR induced consciousness: It's time for sedation protocols for this growing population	Rice DT, Nudell NG, Habrat DA, Smith JE, Ernest EV.	Resuscitation. 2016 Jun;103:e15-e16. doi: 10.1016/j.resuscitation.2016.02.013. Epub 2016 Mar 5.	Resuscitation	2016	10.1016/j.resuscitation.2016.02.013
Insights into the epidemiology of cardiopulmonary resuscitation-induced consciousness in out-of-hospital cardiac arrest	Doan TN, Adams L, Schultz BV, Bunting D, Parker L, Rashford S, Bosley E.	Emerg Med Australas. 2020 Oct;32(5):769-776. doi: 10.1111/1742-6723.13505. Epub 2020 Mar 26.	Emerg Med Australas	2020	10.1111/1742-6723.13505
Analgesic Use in Patients during Cardio-Pulmonary Resuscitation	Dąbrowski S, Lange S, Basiński A.	Int J Environ Res Public Health. 2023 Feb 18;20(4):3654. doi: 10.3390/ijerph20043654.	Int J Environ Res Public Health	2023	10.3390/ijerph20043654
Return of consciousness during ongoing cardiopulmonary resuscitation: A systematic review	Olaussen A, Shepherd M, Nehme Z, Smith K, Bernard S, Mitra B.	Resuscitation. 2015 Jan;86:44-8. doi: 10.1016/j.resuscitation.2014.10.017. Epub 2014 Nov 4.	Resuscitation	2015	10.1016/j.resuscitation.2014.10.017
An exploration of UK paramedics' experiences of cardiopulmonary resuscitation-induced consciousness	Gregory P, Mays B, Kilner T, Sudron C.	Br Paramed J. 2021 Mar 1;5(4):9-17. doi: 10.29045/14784726.2021.3.5.4.9.	Br Paramed J	2021	10.29045/14784726.2021.3.5.4.9
Prehospital anaesthesiologists experience with cardiopulmonary resuscitation-induced consciousness in Norway - A national cross-sectional survey	Brede JR, Skjærseth EÅ, Rehn M.	Resusc Plus. 2024 Feb 29;18:100591. doi: 10.1016/j.resplu.2024.100591. eCollection 2024 Jun.	Resusc Plus	2024	10.1016/j.resplu.2024.100591
Resuscitative endovascular balloon occlusion of the aorta (REBOA) during cardiac resuscitation increased cerebral perfusion to occurrence of cardiopulmonary resuscitation-induced consciousness, a case report	Brede JR, Skjærseth EÅ.	Resusc Plus. 2024 Apr 27;18:100646. doi: 10.1016/j.resplu.2024.100646. eCollection 2024 Jun.	Resusc Plus	2024	10.1016/j.resplu.2024.100646
Awareness during resuscitation: Where is the data?	Varon J.	Am J Emerg Med. 2019 May;37(5):952-953. doi: 10.1016/j.ajem.2019.02.020. Epub 2019 Feb 16.	Am J Emerg Med	2019	10.1016/j.ajem.2019.02.020
BET 2: Pain management in patients who show awareness during CPR	Lundsgaard RS, Lundsgaard KS.	Emerg Med J. 2019 Apr;36(4):249-250. doi: 10.1136/emermed-2019-208599.2.	Emerg Med J	2019	10.1136/emermed-2019-208599.2
Could video assisted CPR improve treatment in complex cardiac arrest situations? - A case report	Einvik S, Ulvin OE, Nordseth T, Uleberg O.	Resusc Plus. 2024 Dec 13;21:100836. doi: 10.1016/j.resplu.2024.100836. eCollection 2025 Jan.	Resusc Plus	2024	10.1016/j.resplu.2024.100836
Cardiac arrest teams perspectives on communication and ethical conflicts related to awareness during CPR, a focus group study protocol	Lundsgaard RS, Lundsgaard KS.	Scand J Trauma Resusc Emerg Med. 2018 Sep 27;26(1):85. doi: 10.1186/s13049-018-0550-x.	Scand J Trauma Resusc Emerg Med	2018	10.1186/s13049-018-0550-x
Assessment of frontal EEG measurement in out-of-hospital cardiac arrest: a prospective observational feasibility study - study protocol	Eichinger M, Zoidl P, Reisinger AC, Orlob S, Hatzl S, Eichlseder M, Pichler A, Eberl A, Kuenzer T, Zajic P, Heuschneider L, Honnef G, Rief M, Bornemann-Cimenti H.	BMJ Open. 2025 Feb 26;15(2):e094258. doi: 10.1136/bmjopen-2024-094258.	BMJ Open	2025	10.1136/bmjopen-2024-094258

📚 Learn More

We just released a podcast episode on CPRIC — where we dig into the origin story, evolving guidelines, sedation strategies, and wild real-life cases.