Gasping after cardiac arrest associated with increased survival

It may confuse bystanders who witness someone suddenly collapsing — especially when the victim is gasping for air. Because of the gasping, the first thought of a bystander may be to skip doing chest compressions and wait for the first responders.

That is exactly what happens frequently and one reason so many cardiac arrest victims do not survive, according to a study in Circulation – a monthly journal published by the American Heart Association. In fact, according to the research, led by Mayo Clinic Arizona Emergency Physician Bentley J. Bobrow and colleagues from the Sarver Heart Center at the University of Arizona, that initial period of distressed breathing may provide the best chance for resuscitation and may give the cardiac arrest victim the best chance to survive.

During a three year period, researchers tracked more than 1,200 cases of witnessed out-of-hospital cardiac arrest attended by emergency medical services personnel in Arizona. Approximately one-third of the patients were gasping on paramedic arrival.

The patients who gasped, compared with those who didn’t, were three times more likely to survive to hospital discharge, but, more compelling, five times more likely to survive if they received bystander cardiopulmonary resuscitation (CPR).

"These results suggest that the recognition and importance of gasping after cardiac arrest should be taught to bystanders and emergency personnel," says Dr. Bobrow. "There is a knowledge gap in terms of people recognising that gasping or other laboured breathing sounds should be acted on by immediately starting CPR — to delay this may mean decreasing survival for the patient." In fact, note the researchers, gasping is an indication that the brain is still alive and functioning and CPR is working.

Also important, don’t give up if the patient continues to gasp, warns Dr. Bobrow, who is also medical director for the Arizona Department of Health Emergency Medical Services. "Gasping is not a sign of recovery, but is a signal that resuscitation efforts are effective and should be continued to increase the chance of survival."

Gasping should not be confused with "choking," according to the Arizona researchers, who say that people who exhibit choking and indicate such by pointing to their throat are actually responsive and in need of being administered the Heimlich manoeuvre.

"Recognition of gasping and its significance in patients with primary cardiac arrest is important to successful resuscitation efforts," adds Dr. Bobrow.

Out-of-hospital cardiac arrest is a common cause of death in the U.S. and is known as a major public health problem.

(Source: Circulation: Mayo Clinic: January 2009)