# CPR-induced consciousness in hypothermic cardiac arrest: Where is the limit of tolerance of the human brain? A case report

## TL;DR

A man in hypothermic cardiac arrest showed signs of consciousness during CPR and recovered without brain damage, possibly due to hypothermia's protective effects.

## Contribution

First reported case of CPR-induced consciousness in hypothermic cardiac arrest with neurological recovery.

## Key findings

- A hypothermic cardiac arrest patient showed signs of consciousness during CPR.
- The patient recovered without neurological deficits after being rewarmed with V-A ECMO.
- Hypothermia may protect the brain during cardiac arrest despite other injury risks.

## Abstract

CPR-induced consciousness (CPRIC) is defined as consciousness during CPR, ranging from eye opening to combative behaviour and vocalisation, despite the absence of spontaneous circulation. CPRIC has not previously been reported in hypothermic cardiac arrest.

A middle-aged man who was pulled from cold water appeared conscious during CPR, despite confirmed cardiac arrest and severe accidental hypothermia. An additional factor that could have influenced the victim’s behaviour was severe hypoglycaemia. The patient was rewarmed with veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and discharged from the hospital without any neurological deficits.

In hypothermic cardiac arrest, the paradoxical preservation of consciousness may be a consequence of adequate cerebral perfusion during cardiopulmonary resuscitation and the neuroprotective effect of hypothermia, despite other risk factors for brain injury.

The online version contains supplementary material available at 10.1186/s13049-025-01426-y.