• Shailesh Bihari and Venkatakrishna Rajajee.
• Critical Care Unit, Apollo Hospitals, No. 21, Greams Lane, Chennai, 600 006, Tamilnadu, India.
• Neurocrit Care. 2008 Jan 1;9(3):382-6.

ObjectiveTo describe high level of awareness in a patient undergoing cardiopulmonary resuscitation for an asystolic cardiac arrest and review the literature regarding this phenomenon.MethodsThis is a case report of a patient admitted to the Intensive Care Unit who suffered an asystolic cardiac arrest. We reviewed MEDLINE using the terms "awareness," "consciousness," "cerebral perfusion," "sedation," "analgesia," "termination," "cessation," and "cardiopulmonary resuscitation."ResultsA 57-year-old man with renal failure suffered asystolic cardiac arrest. He was awake and alert during cardiopulmonary resuscitation (CPR). Cardiac arrest was confirmed by echocardiogram and invasive arterial monitoring. He briskly localized and consistently followed simple commands while chest compressions were in progress before becoming unresponsive and dying after a 3-h resuscitative effort. No sedation/analgesia was used. There are few reports in the literature describing similar events.ConclusionIt is possible to retain a high level of awareness following cardiac arrest, particularly with effective CPR. Recognition of this situation when it occurs allows appropriate decisions to be made regarding the use of sedation and the length of resuscitative efforts.

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