Background Gasping is a natural reflex that enhances oxygenation and circulation during cardiopulmonary resuscitation (CPR). Objectives This study sought to assess the relationship between gasping during out-of-hospital cardiac arrest and 1-year survival with favorable neurological outcomes. Methods The authors prospectively collected incidence of gasping on all evaluable subjects in a multicenter, randomized, controlled, National Institutes of Health–funded out-of-hospital cardiac arrest clinical trial from August 2007 to July 2009. The association between gasping and 1-year survival with favorable neurological function, defined as a Cerebral Performance Category (CPC) score ≤2 was estimated using multivariable logistic regression. Results The rates of 1-year survival with a CPC score of ≤2 were 5.4% (98 of 1,827) overall, and 20% (36 of 177) and 3.7% (61 of 1,643) for individuals with and without spontaneous gasping or agonal respiration during CPR, respectively. In multivariable analysis, 1-year survival with CPC ≤2 was independently associated with younger age (odds ratio [OR] for 1 SD increment 0.57; 95% confidence interval [CI]: 0.43 to 0.76), gasping during CPR (OR: 3.94; 95% CI: 2.09 to 7.44), shockable initial recorded rhythm (OR: 16.50; 95% CI: 7.40 to 36.81), shorter CPR duration (OR: 0.31; 95% CI: 0.19 to 0.51), lower epinephrine dosage (OR: 0.47; 95% CI: 0.25 to 0.87), and pulmonary edema (OR: 3.41; 95% CI: 1.53 to 7.60). Gasping combined with a shockable initial recorded rhythm had a 57-fold higher OR (95% CI: 23.49 to 136.92) of 1-year survival with CPC ≤2 versus no gasping and no shockable rhythm. Conclusions Gasping during CPR was independently associated with increased 1-year survival with CPC ≤2, regardless of the first recorded rhythm. These findings underscore the importance of not terminating resuscitation prematurely in gasping patients and the need to routinely recognize, monitor, and record data on gasping in all future cardiac arrest trials and registries.
Bibliographical noteFunding Information:
The original trial was funded by National Institutes of Health grant R44-HL065851-03 and Advanced Circulatory Systems. This prospective observational study did not receive specific funding. The funder of the original trial had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Dr. O’Neil has served on an advisory board; and has been a principal investigator for Zoll Circulation. Dr. Aufderheide has received research grants from the National Heart, Lung, and Blood Institute: Resuscitation Outcomes Consortium, NIH Director's Transformative Grant for the ACCESS trial, and the National Institute of Neurological Disorders and Stroke: Neurological Emergencies Treatment Trials and Strategies to Innovate Emergency Care Clinical Trials. Dr. Lurie is a consultant for ZOLL Medical and Minnesota Resuscitation Solutions; and is the inventor of the Impedance Threshold Device and Active Compression Decompression CPR. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
© 2017 American College of Cardiology Foundation
- agonal breathing
- cardiac arrest
- cardiopulmonary resuscitation