Agonal breathing predicts survival from cardiac arrest

A recent by heartwire gives an overview of:

Bobrow BJ, Zuercher M, Ewy GA, et al., Gasping during cardiac arrest in humans is frequent and associated with improved survival. Circulation. Published online before print November 24, 2008.

gasping

Among the highlights:

Someone stricken with out-of-hospital cardiac arrest might still be gasping for air, but that’s no reason for witnesses to avoid jumping in with chest compressions, according to researchers who studied the phenomenon. On the contrary, that initial period of distressed breathing might last only minutes but provides the best chance for resuscitation efforts to succeed and allow the patient to survive to hospital discharge.

According to coauthor Dr Gordon A Ewy (University of Arizona Sarver Heart Center):

The gasping is a sign of poor but marginally adequate cerebral perfusion, and it is promising whether it starts as the patient collapses or only after the beginning of CPR […] Lay people who initiate CPR tend to be startled if gasping occurs, believing the patient is ‘waking up,’ and then often stop what they are doing […] but, ‘gasping is an indication that you’re doing a great job and you shouldn’t stop.’

The article goes on to explain:

Ewy is among the principal advocates of what he calls cardiocerebral resuscitation for arrest of cardiac origin, characterized most notably by an emphasis on chest compressions uninterrupted by assisted breathing. The technique […] was recently endorsed by the American Heart Association as being about as effective as the traditional method involving compressions plus “mouth to mouth” resuscitation.

But proponents of the chest-compression-only method say it is superior, not only in being more successful but in encouraging bystanders to attempt it in the first place. In fact, Ewy said, the current study was designed, in part, to help get the public and providers to see abnormal breathing as a reason to initiate or continue CPR rather than a reason to stop or avoid it.

Our dispatchers have a very important role in encouraging bystanders to perform CPR. Telecommunicator CPR (T-CPR) can buy precious minutes for EMS to arrive on scene and implement Pit Crew / High Performance CPR.

The only questions that need to be asked (after confirming the address) are:

  1. Is the patient conscious?
  2. Is the patient breathing normally?

If the answers are “no” and “no” immediate CPR instructions should be given. This is a huge opportunity for improvement for most EMS systems. Agonal gasps are a huge roadblock to bystander CPR! The evidence shows it is very unlikely that a patient will be harmed if it turns out they do not need CPR.

See also

Telecommunicator CPR (T-CPR) Certificate Course at the Resuscitation Academy

Updated 04/22/2016

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