In patients with cardiopulmonary resuscitation-induced consciousness in cardiac arrest in the pre-hospital setting, does the use of pharmacological interventions impact mortality compared to standard care? A systematic review.

Authors

Nora Prokop, Alan Rice, Mark Durham

Published in

British paramedic journal. Volume 11. Issue 2. Pages 29-35. Sep 01, 2026.

Abstract

Cardiopulmonary resuscitation-induced consciousness (CPRIC) is the term commonly used to refer to signs of life displayed by patients during resuscitation. This phenomenon presents a challenge, as these signs of life can interfere with resuscitative efforts. International resuscitation guidelines currently do not recommend a specific treatment strategy. This systematic review aimed to ascertain whether pharmacological management of adult cardiac arrest patients with CPRIC in the pre-hospital setting had an impact on mortality rates compared to standard care. The review also aimed to identify any association between use of specific pharmacological agents and mortality.
Studies that reported on adult cardiac arrest patients presenting with CPRIC who received pharmacological management and were resuscitated in the pre-hospital setting were included. The literature search excluded studies that did not provide mortality data. The search was conducted using PubMED, CINAHL and Embase. A narrative synthesis approach was used to report the results.
Two studies were identified by the literature search. Both articles were Australian retrospective observational cohort studies that included a total of 39,569 patients, of which 164 presented with CPRIC. Patients with CPRIC were found to be more likely to survive than those without. Patients who were managed with medications had a lower survival rate than those who were not. Due to limited and heterogeneous data, a meta-analysis was not conducted.
The evidence produced included a significant number of confounding factors, limiting both internal and external validity of this review. Overall, the confidence in the results is low and the findings cannot be generalised to clinical practice. This review did, however, highlight the need for further research on the pre-hospital management of CPRIC. This is especially emphasised by increases in mortality in those treated with midazolam and by the fact that the only available evidence pertains to midazolam, despite an increasing prevalence of other agents being used.

PMID:
42683417
Bibliographic data and abstract were imported from PubMed on 02 Sep 2026.

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