CPR induced consciousness: It's time for sedation protocols for this growing population.

Sir, In 2015, the Leona Helmsley Foundation granted the State of ebraska close to 6 million dollars for the deployment and training f the LUCAS® 2 Chest Compression System.1 After deployment, eports of patients regaining consciousness during CPR began to urface. The state EMS office evaluated whether there was a potenial gap in care and whether sedation policies were needed. In 2015, paramedics in Nebraska responded to a 55-year-old ale with a history of coronary artery disease and stent placement. prehospital 12-lead ECG showed evidence of an inferior myocarial infarction with ST elevation in leads II, III, and AVF. The patient oon deteriorated into ventricular fibrillation (V-fib). After approxmately 20 s of CPR and a single defibrillation the patient had return f spontaneous circulation (ROSC). After arriving in the emergency department, his V-fib reocurred. The patient remained awake, alert, able to speak, and ngaged in purposeful movements during chest compressions. The D staff was able to communicate to the patient including warning im when they were going to defibrillate. He was sedated with mg/kg of ketamine for continued consciousness and was successully intubated. After 23 min of resuscitation efforts, he attained ustained ROSC. Angiography revealed a 100% occlusion of the roximal right coronary artery. The patient was interviewed prior to discharge. He was able to learly recall the events in the ED up until the time of ketamine dministration. After his ketamine bolus, he then described a