Gasping During Cardiac Arrest Is Associated with Improved Survival
Gasping is common and should not delay initiation of CPR.
Early and uninterrupted bystander cardiopulmonary resuscitation is often critical to patient survival after cardiac arrest. However, the presence of agonal or gasping respirations might delay recognition of arrest and, therefore, delay initiation of CPR. Researchers retrospectively reviewed cardiac arrest reports from Arizona emergency medical services systems to assess the frequency of gasping respirations in adults with out-of-hospital nontraumatic cardiac arrest.
Patients were excluded if they had obvious signs of death, do-not-resuscitate orders, or arrest secondary to drowning. Overall, 44 of 113 patients (39%) had reports of gasping. Although similar proportions of patients with and without reports of gasping received bystander CPR, the group with gasping had a significantly higher rate of survival to hospital discharge (odds ratio for survival, 3.4). The authors conclude that abnormal breathing is common after cardiac arrest and that the public and medical dispatchers should be made aware of this finding.
Agonal or gasping respirations are hallmarks of cerebral hypoperfusion. Although this retrospective study likely underestimated the incidence of gasping, the findings suggest that it is common immediately after cardiac arrest. As we learn more about the meaning and prognostic significance of gasping, the challenge will be to help the public to understand that CPR should be initiated even when gasping is present.
Aaron E. Bair, MD, MSc, FAAEM, FACEP
Published in Journal Watch Emergency Medicine January 9, 2009
Bobrow BJ et al. Gasping during cardiac arrest in humans is frequent and associated with improved survival. Circulation 2008 Dec 9; 118:2550