Gasping and Neurologic Outcome in Cardiac Arrest

Study Questions:

What is the relationship between gasping during out-of-hospital cardiac arrest (OHCA) and 1-year survival with favorable neurological outcome?

Methods:

The investigators prospectively collected incidence of gasping on all evaluable subjects in a multicenter, randomized, controlled National Institutes of Health–funded OHCA 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% (98/1,827) overall, and 20% (36/177) and 3.7% (61/1,643) for individuals with and without spontaneous gasping or agonal respiration during cardiopulmonary resuscitation (CPR), respectively. In multivariable analysis, 1-year survival with a CPC score ≤2 was independently associated with younger age (odds ratio [OR] for 1 standard deviation increment, 0.57; 95% confidence interval [CI], 0.43-0.76), gasping during CPR (OR, 3.94; 95% CI, 2.09-7.44), shockable initial recorded rhythm (OR, 16.50; 95% CI, 7.40-36.81), shorter CPR duration (OR, 0.31; 95% CI, 0.19-0.51), lower epinephrine dosage (OR, 0.47; 95% CI, 0.25- 0.87), and pulmonary edema (OR, 3.41; 95% CI, 1.53-7.60). Gasping combined with a shockable initial recorded rhythm had a 57-fold higher OR (95% CI, 23.49-136.92) of 1-year survival with CPC ≤2 versus no gasping/no shockable rhythm.

Conclusions:

The authors concluded that gasping during CPR was independently associated with increased 1-year survival with a CPC score ≤2, regardless of the first recorded rhythm.

Perspective:

This study reports that the occurrence of spontaneous gasping during CPR, a natural marker for the presence of brainstem activity, was independently associated with 3.9-fold higher odds of long-term survival with good brain function. Furthermore, gasping was more highly associated with 1-year survival with good brain function than any predictive variable other than ventricular fibrillation/ventricular tachycardia as the first recorded rhythm. Recognition of gasping during CPR may provide a potential rationale for not terminating chest compressions or inhibiting spontaneous inspiratory efforts in a gasping patient during CPR. Additional prospective studies are indicated to validate these observational findings.

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Cardiopulmonary Resuscitation, Epinephrine, Heart Arrest, Neurologic Examination, Outcome Assessment (Health Care), Out-of-Hospital Cardiac Arrest, Pulmonary Edema, Secondary Prevention, Shock, Survival Analysis, Tachycardia, Ventricular, Ventricular Fibrillation


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