• Sam Parnia, Tara Keshavarz Shirazi, Jignesh Patel, Linh Tran, Niraj Sinha, Caitlin O'Neill, Emma Roellke, Amanda Mengotto, Shannon Findlay, Michael McBrine, Rebecca Spiegel, Thaddeus Tarpey, Elise Huppert, Ian Jaffe, Anelly M Gonzales, Jing Xu, Emmeline Koopman, Gavin D Perkins, Alain Vuylsteke, Benjamin M Bloom, Heather Jarman, Hiu Nam Tong, Louisa Chan, Michael Lyaker, Matthew Thomas, Veselin Velchev, Charles B Cairns, Rahul Sharma, Erik Kulstad, Elizabeth Scherer, Terence O'Keeffe, Mahtab Foroozesh, Olumayowa Abe, Chinwe Ogedegbe, Amira Girgis, Deepak Pradhan, and Charles D Deakin.
• Critical Care and Resuscitation Research Program, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA. Electronic address: sam.parnia@nyulangone.org.
• Resuscitation. 2023 Oct 1; 191: 109903109903.

IntroductionCognitive activity and awareness during cardiac arrest (CA) are reported but ill understood. This first of a kind study examined consciousness and its underlying electrocortical biomarkers during cardiopulmonary resuscitation (CPR).MethodsIn a prospective 25-site in-hospital study, we incorporated a) independent audiovisual testing of awareness, including explicit and implicit learning using a computer and headphones, with b) continuous real-time electroencephalography(EEG) and cerebral oxygenation(rSO2) monitoring into CPR during in-hospital CA (IHCA). Survivors underwent interviews to examine for recall of awareness and cognitive experiences. A complementary cross-sectional community CA study provided added insights regarding survivors' experiences.ResultsOf 567 IHCA, 53(9.3%) survived, 28 of these (52.8%) completed interviews, and 11(39.3%) reported CA memories/perceptions suggestive of consciousness. Four categories of experiences emerged: 1) emergence from coma during CPR (CPR-induced consciousness [CPRIC]) 2/28(7.1%), or 2) in the post-resuscitation period 2/28(7.1%), 3) dream-like experiences 3/28(10.7%), 4) transcendent recalled experience of death (RED) 6/28(21.4%). In the cross-sectional arm, 126 community CA survivors' experiences reinforced these categories and identified another: delusions (misattribution of medical events). Low survival limited the ability to examine for implicit learning. Nobody identified the visual image, 1/28(3.5%) identified the auditory stimulus. Despite marked cerebral ischemia (Mean rSO2 = 43%) normal EEG activity (delta, theta and alpha) consistent with consciousness emerged as long as 35-60 minutes into CPR.ConclusionsConsciousness. awareness and cognitive processes may occur during CA. The emergence of normal EEG may reflect a resumption of a network-level of cognitive activity, and a biomarker of consciousness, lucidity and RED (authentic "near-death" experiences).Copyright © 2023. Published by Elsevier B.V.

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