By Gordon A. Ewy, MD

SHARE Consortium and the UA Sarver Heart Center Resuscitation Research Group rediscovered a fact that cannot be emphasized enough, both to experts in the field of resuscitation science and to the public.

More than half the patients in cardiac arrest gasp. Gasping has been described as snoring, gurgling, moaning, snorting, agonal or labored breathing. However, bystanders often misinterpret gasping and other unusual vocal sounds as breathing and do not call 9-1-1 or begin lifesaving chest compressions quickly enough. Or, they call 9-1-1 and when asked by the dispatcher if the patient is breathing, they often say ‘Yes’ – leading the dispatcher to believe it is not a cardiac arrest and give inappropriate recommendations to the rescuer. A few minutes later, the gasping stops, and only when the rescuer reports back to the dispatcher do they realize they are dealing with cardiac arrest. By that time, precious minutes have been wasted during which the patient’s brain and heart have not received any blood flow.

Usually, this gasping or agonal breathing stops within about four minutes, which is why many experts have not recognized this phenomenon so far! Gasping is a survival reflex triggered by the brain and can increase the chances of survival for someone in cardiac arrest.

“Gasping is an indication that the brain is still alive and it tells you that if you start and continue uninterrupted chest compressions, the person has a high chance of surviving. The challenge is to educate bystanders that if they are helping someone in cardiac arrest, not to mistake gasping for breathing. Contrary as it may seem, a person who is gasping is not OK – they need chest compressions. Bystanderinitiated CPR has been shown to be a cardiac arrest victim’s only chance of survival until an automated external defibrillator (AED) or the paramedics get to the scene.

Many bystanders are hesitant to perform mouth-to-mouth ventilation, and in a case of a witnessed (seen or heard) collapse, so-called rescue breathing is not necessary and may be harmful. When the patient gasps, there is a negative pressure in the chest, which not only sucks air into the lungs but also draws blood to refill the heart. In contrast, mouth-to-mouth breathing creates overpressure in the chest and actually inhibits blood flow back to the heart. Gasping during cardiac arrest is much

better than mouth-to-mouth breathing.

But what about choking? That’s very different. Someone who is choking will be seen to grasp their throat and struggle to breathe, which means they’re responsive. These individuals need the Heimlich maneuver. A primary cardiac arrest is the witnessed, unexpected collapse of an individual who is not responsive. Cardiac arrest will cause the stricken individual to pass out and collapse within seconds.Rarely, a patient with cardiac arrest will have a seizure.

Bentley J. Bobrow, MD, medical director of the Bureau of Emergency Medical Services & Trauma System at the Arizona Department of Health Services, examined data from two sources. Transcripts from the Phoenix Fire Department Regional Dispatch Center included information on gasping in patients found by bystanders, whether their collapse was witnessed or not. The department’s first-care reports on 1,218 witnessed patients provided the incidence of gasping upon or after the arrival of emergency medical service (EMS) personnel. Among the 481 patients who received bystander CPR, 39 percent of gaspers survived, but only 9 percent of those who did not gasp survived.

Performing uninterrupted chest compressions may cause a person who has stopped gasping to resume gasping. This scares many people and they stop pressing on the chest, but gasping is an indication that you’re doing a good job. Keep up continuous chest compressions! ♥