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(Circulation. 2008;118:2550-2554.)
© 2008 American Heart Association, Inc.

Resuscitation Science

Gasping During Cardiac Arrest in Humans Is Frequent and Associated With Improved Survival

Bentley J. Bobrow, MD; Mathias Zuercher, MD; Gordon A. Ewy, MD; Lani Clark, BS; Vatsal Chikani, MPH; Dan Donahue, BS, NREMT-P; Arthur B. Sanders, MD; Ronald W. Hilwig, DVM; Robert A. Berg, MD; Karl B. Kern, MD

From the Arizona Department of Health Services Bureau of Emergency Medical Services and Trauma System, Phoenix, Ariz (B.J.B., L.C., V.C.); Department of Emergency Medicine, Mayo Clinic Hospital, and the Mayo Clinic College of Medicine, Phoenix, Ariz (B.J.B.); University of Arizona Sarver Heart Center, Tucson (B.J.B., G.A.E., L.C., A.B.S., R.W.H., R.A.B., K.B.K.); Department of Anesthesiology, University of Basel, Basel, Switzerland (M.Z.); Departments of Medicine (G.A.E., K.B.K.), Emergency Medicine (A.B.S.), and Pediatrics (R.A.B.), University of Arizona College of Medicine; and Phoenix Fire Department, Phoenix, Ariz (D.D.).

Correspondence to Gordon A. Ewy, MD, University of Arizona Sarver Heart Center, 1501 N Campbell Ave, Tucson, AZ 85724. E-mail gaewy{at}aol.com

Received June 19, 2008; accepted September 19, 2008.

Background— The incidence and significance of gasping after cardiac arrest in humans are controversial.

Methods and Results— Two approaches were used. The first was a retrospective analysis of consecutive confirmed out-of-hospital cardiac arrests from the Phoenix Fire Department Regional Dispatch Center text files to determine the presence of gasping soon after collapse. The second was a retrospective analysis of 1218 patients with out-of-hospital cardiac arrests in Arizona documented by emergency medical system (EMS) first-care reports to determine the incidence of gasping after arrest in relation to the various EMS arrival times. The primary outcome measure was survival to hospital discharge. An analysis of the Phoenix Fire Department Regional Dispatch Center records of witnessed and unwitnessed out-of-hospital cardiac arrests with attempted resuscitation found that 44 of 113 (39%) of all arrested patients had gasping. An analysis of 1218 EMS-attended, witnessed, out-of-hospital cardiac arrests demonstrated that the presence or absence of gasping correlated with EMS arrival time. Gasping was present in 39 of 119 patients (33%) who arrested after EMS arrival, in 73 of 363 (20%) when EMS arrival was <7 minutes, in 50 of 360 (14%) when EMS arrival time was 7 to 9 minutes, and in 25 of 338 (7%) when EMS arrival time was >9 minutes. Survival to hospital discharge occurred in 54 of 191 patients (28%) who gasped and in 80 of 1027 (8%) who did not (adjusted odds ratio, 3.4; 95% confidence interval, 2.2 to 5.2). Among the 481 patients who received bystander cardiopulmonary resuscitation, survival to hospital discharge occurred among 30 of 77 patients who gasped (39%) versus only 38 of 404 among those who did not gasp (9%) (adjusted odds ratio, 5.1; 95% confidence interval, 2.7 to 9.4).

Conclusions— Gasping or abnormal breathing is common after cardiac arrest but decreases rapidly with time. Gasping is associated with increased survival. These results suggest that the recognition and importance of gasping should be taught to bystanders and emergency medical dispatchers so as not to dissuade them from initiating prompt resuscitation efforts when appropriate.

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CLINICAL PERSPECTIVE

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