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Gasping Respirations and CPR

Author(s): Tod Schimelpfenig
Posted: January 20, 2009

There have been a number of lay press articles and comments bouncing around the internet about the recent study speaking to gasping breathing  and CPR.

They are talking about a phenomena known to experienced field medical people; gasping, snorting, gurgling, moaning sounds, also know as agonal breathing, in patients without a pulse.  The study seems to support observations of EMT’s and Paramedics that these weird breaths are associated with a better chance to save the patient.

The retrospective study showed that gasping breathing is more common than thought (33% in one subset), is most frequent soon after cardiac arrest, and  decreases as the time in cardiac arrest progresses.  Gasping might be associated with a higher survival rate.  Among the patients in this study who received bystander CPR, survival to hospital discharge was 39% in patients who gasped and 9% in non-gasping patients.

That’s the upside.  The downside is that the gasps may be mistaken for adequate breathing, and delay CPR.   Lay people are no longer trained to check for a pulse, they look for signs of circulation; coughing, breathing and movement.  This study makes me wonder about the times I’ve entered a scene to find a patient in cardiac arrest and bystanders standing by, not doing chest compressions.  Did they confuse agonal breathing for a sign of circulation?

The Heart Association speaks to agonal breathing in their curriculum and tells us not  to confuse this for normal breathing and to start CPR immediately.   

There is a video image of gasping breathing at www.americanheart.org/presenter.jhtml?identifier=3061873.

The original article:
Bobrow BJ et al. Gasping during cardiac arrest in humans is frequent and associated with improved survival. Circulation 2008 Dec 9; 118:2550. 

Medline abstract (free) www.ncbi.nlm.nih.gov/pubmed/19029463?dopt=Abstract

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