title: AWARE-AWAreness during REsuscitation-a prospective study.
abstract: BACKGROUND
  Cardiac arrest (CA) survivors experience cognitive deficits including post-traumatic stress disorder (PTSD). It is unclear whether these are related to cognitive/mental experiences and awareness during CPR. Despite anecdotal reports the broad range of cognitive/mental experiences and awareness associated with CPR has not been systematically studied.
  
  
  METHODS
  The incidence and validity of awareness together with the range, characteristics and themes relating to memories/cognitive processes during CA was investigated through a 4 year multi-center observational study using a three stage quantitative and qualitative interview system. The feasibility of objectively testing the accuracy of claims of visual and auditory awareness was examined using specific tests. The outcome measures were (1) awareness/memories during CA and (2) objective verification of claims of awareness using specific tests.
  
  
  RESULTS
  Among 2060 CA events, 140 survivors completed stage 1 interviews, while 101 of 140 patients completed stage 2 interviews. 46% had memories with 7 major cognitive themes: fear; animals/plants; bright light; violence/persecution; deja-vu; family; recalling events post-CA and 9% had NDEs, while 2% described awareness with explicit recall of 'seeing' and 'hearing' actual events related to their resuscitation. One had a verifiable period of conscious awareness during which time cerebral function was not expected.
  
  
  CONCLUSIONS
  CA survivors commonly experience a broad range of cognitive themes, with 2% exhibiting full awareness. This supports other recent studies that have indicated consciousness may be present despite clinically undetectable consciousness. This together with fearful experiences may contribute to PTSD and other cognitive deficits post CA.
authors.affiliation: Stony Brook Medical Center, State University of New York at Stony Brook, NY, USA. Electronic address: sam.parnia@stonybrookmedicine.edu.
authors.forename: Sam
authors.initials: S
authors.lastname: Parnia
authors.affiliation: Hammersmith Hospital Imperial College, University of London, UK.
authors.forename: Ken
authors.initials: K
authors.lastname: Spearpoint
authors.affiliation: Montefiore Medical Center, New York, USA.
authors.forename: Gabriele
authors.initials: G
authors.lastname: de Vos
authors.affiliation: University Hospital Southampton, Southampton, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Fenwick
authors.affiliation: Stony Brook Medical Center, State University of New York at Stony Brook, NY, USA.
authors.forename: Diana
authors.initials: D
authors.lastname: Goldberg
authors.affiliation: Stony Brook Medical Center, State University of New York at Stony Brook, NY, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Yang
authors.affiliation: Stony Brook Medical Center, State University of New York at Stony Brook, NY, USA.
authors.forename: Jiawen
authors.initials: J
authors.lastname: Zhu
authors.affiliation: University Hospital Southampton, Southampton, UK.
authors.forename: Katie
authors.initials: K
authors.lastname: Baker
authors.affiliation: Royal Bournemouth Hospital, Bournemouth, UK.
authors.forename: Hayley
authors.initials: H
authors.lastname: Killingback
authors.affiliation: St Georges Hospital, University of London, UK.
authors.forename: Paula
authors.initials: P
authors.lastname: McLean
authors.affiliation: St Georges Hospital, University of London, UK.
authors.forename: Melanie
authors.initials: M
authors.lastname: Wood
authors.affiliation: Emory University School of Medicine & Atlanta Veterans Affairs Medical Center, Atlanta, USA.
authors.forename: A Maziar
authors.initials: AM
authors.lastname: Zafari
authors.affiliation: Emory University School of Medicine & Atlanta Veterans Affairs Medical Center, Atlanta, USA.
authors.forename: Neal
authors.initials: N
authors.lastname: Dickert
authors.affiliation: Medical University of Vienna, Austria.
authors.forename: Roland
authors.initials: R
authors.lastname: Beisteiner
authors.affiliation: Medical University of Vienna, Austria.
authors.forename: Fritz
authors.initials: F
authors.lastname: Sterz
authors.affiliation: Medical University of Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Berger
authors.affiliation: Northampton General Hospital, Northampton, UK.
authors.forename: Celia
authors.initials: C
authors.lastname: Warlow
authors.affiliation: Northampton General Hospital, Northampton, UK.
authors.forename: Siobhan
authors.initials: S
authors.lastname: Bullock
authors.affiliation: Lister Hospital, Stevenage, UK.
authors.forename: Salli
authors.initials: S
authors.lastname: Lovett
authors.affiliation: Cedar Sinai, USA.
authors.forename: Russell Metcalfe Smith
authors.initials: RM
authors.lastname: McPara
authors.affiliation: Croydon University Hospital, UK.
authors.forename: Sandra
authors.initials: S
authors.lastname: Marti-Navarette
authors.affiliation: James Paget Hospital, UK.
authors.forename: Pam
authors.initials: P
authors.lastname: Cushing
authors.affiliation: Ashford & St Peters NHS Trust, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Wills
authors.affiliation: University Hospital Southampton, Southampton, UK.
authors.forename: Kayla
authors.initials: K
authors.lastname: Harris
authors.affiliation: Addenbrookes Hospital, University of Cambridge, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Sutton
authors.affiliation: East Sussex Hospital, East Sussex, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Walmsley
authors.affiliation: University Hospital Southampton, Southampton, UK.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Deakin
authors.affiliation: University Hospital Southampton, Southampton, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.affiliation: Indiana University, Wishard Memorial Hospital, Indianapolis, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Farber
authors.affiliation: University of Virginia, Charlottesville, VA, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Greyson
authors.affiliation: Stony Brook Medical Center, State University of New York at Stony Brook, NY, USA.
authors.forename: Elinor R
authors.initials: ER
authors.lastname: Schoenfeld
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D001364:Awareness; D001921:Brain / Q000503:physiopathology*; D016887:Cardiopulmonary Resuscitation / Q000401:mortality / Q000523:psychology*; D003243:Consciousness; D005201:Fantasy; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008297:Male; D011939:Mental Recall / Q000502:physiology*; D008875:Middle Aged; D010268:Parapsychology / Q000379:methods; D011446:Prospective Studies; D017741:Survivors; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: Awareness; Cardiac arrest; Consciousness; Explicit memory; Implicit memory; Near death experiences; Out of body experiences; Post traumatic stress disorder