BackgroundCPR-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.

Patient presentationA 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.

ConclusionsIn 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.