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