Faculty Collaboration Database

Long-Term Prognostic Value of Gasping During Out-of-Hospital Cardiac Arrest. J Am Coll Cardiol 2017 Sep 19;70(12):1467-1476

Date

09/16/2017

Pubmed ID

28911510

DOI

10.1016/j.jacc.2017.07.782

Scopus ID

2-s2.0-85031107092 (requires institutional sign-in at Scopus site)   40 Citations

Abstract

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.

Author List

Debaty G, Labarere J, Frascone RJ, Wayne MA, Swor RA, Mahoney BD, Domeier RM, Olinger ML, O'Neil BJ, Yannopoulos D, Aufderheide TP, Lurie KG

Author

Tom P. Aufderheide MD Professor in the Emergency Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Female
Humans
Inhalation
Male
Middle Aged
Out-of-Hospital Cardiac Arrest
Prognosis
Prospective Studies
Survival Rate
Tachycardia, Ventricular
Time Factors
Ventricular Fibrillation
Young Adult