Gasping during cardiac arrest linked to improved survival, brain function

Gasping during cardiac arrest was associated with a nearly four-fold increase of one-year survival with favorable brain function, according to a study of 1,888 out-of-hospital cardiac arrests (OHCAs).

When combined with an initial shockable rhythm, gasping was linked to a 57-fold higher rate of one-year survival with favorable neurological function than victims displaying neither characteristic.

In their study published in the Journal of the American College of Cardiology, Guillaume Debaty, MD, and colleagues wrote the findings highlight the importance of continuing cardiopulmonary resuscitation (CPR) when gasping is present. Often, they pointed out, gasping in the early stages of cardiac arrest is mistaken for normal breathing, leading to a delay in response times.

“The study results demonstrate that during CPR the occurrence of spontaneous gasping, a natural biomarker for the presence of brainstem activity, was independently associated with a 3.9-fold higher odds of long-term survival with good brain function,” wrote Debaty, with the department of emergency medicine at University Hospital of Grenoble Alps in France, and colleagues.

“To our knowledge, this study is the first to report a relationship between long-term survival with favorable neurological function after OHCA and gasping or agonal breathing before or during CPR.”

Researchers gathered OHCA data from a multicenter, randomized clinical trial conducted from 2007 to 2009. Using call-in reporting data and emergency medical services run sheets, they determined whether gasping or agonal respirations were documented. The mean age for all 1,888 victims was 64 years, with 63 percent being male.

Debaty et al. analyzed one-year survival rates with an emphasis on favorable brain function, defined as a Cerebral Performance Category (CPC) score of 1 or 2.

Fewer than 10 percent of victims had documented gasping during OHCA, but that group comprised more than one-third of the long-term survivors with a favorable CPC score.

“Regardless of the presenting rhythm, 37 percent of survivors with favorable brain function had agonal respirations during CPR,” they wrote. “Moreover, gasping was more highly associated with one-year survival with good brain function than any predictive variable other than ventricular fibrillation or ventricular tachycardia as the first recorded rhythm.”

Based on the prognostic value of their findings, the researchers suggested collecting data on gasping in all future CPR trials and registries.