Abstract P56: Gasping During Cardiac Arrest in Humans is Frequent, Associated with Improved Survival, and Needs Re-emphasis
Background: The incidence and significance of gasping following cardiac arrest in man is controversial.
Objective: The purpose of this study was to determine the current incidence of gasping and its effect on survival of patients with out-of-hospital cardiac arrest (OHCA).
Methods: The incidence of gasping when Emergency Medical Services (EMS) was called was determined by a retrospective analysis of 113 consecutive, confirmed OHCAs from the Phoenix Alarm Room Emergency Medical Dispatcher (EMD) database from January 1, 2008 until January 31, 2008. Additionally, a retrospective analysis was done to determine the incidence of gasping at various EMS arrival time intervals and to determine the effect of gasping on survival of patients with OHCA. EMS first care reports for 1218 OHCAs occurring between January 1, 2005 and December 31, 2007 were analyzed for documentation of gasping at EMS arrival time.
Results: An analysis of EMD records of 113 OHCAs on whom resuscitation was attempted, both witnessed and unwitnessed, found that 44/113 (39%) of all arrested patients had abnormal breathing. An analysis of 1218 OHCAs found gasping correlated with the EMS arrival time. Gasping was present 27% of all OHCAs when EMS response time was ≤3 minutes, in 21% when the response time was between 3 and 6 minutes, 15% when the response time was between 6 and 8 minutes, and 8% when the response time was >8 minutes. The survival was 54/191 (28%) of patients who gasped and 80/1027 (8%) of those who did not (P <0.0001). Among the 191 patients who were gasping on arrival of EMS, 30/77 (39%) receiving bystander resuscitation survived while only 24/114 (21%) who were not receiving bystander resuscitation lived to hospital discharge (P <0.01).
Conclusions: Gasping or agonal breathing is common following cardiac arrest but decreases rapidly with time. Bystander resuscitation efforts during gasping are associated with increased survival. These observations suggest that gasping and other forms of abnormal breathing in patients with cardiac arrest should be taught with more emphasis to emergency medical dispatchers and to all bystanders so as not to dissuade them from initiating resuscitation efforts through misinterpretation of gasping as an indication of breathing.