Gasping Cardiac Patients Need CPR
Don't Hold Off Chest Compressions if Cardiac Patient Is Gasping
Nov. 24 2008 -- People in cardiac arrest need CPR -- even if they're gasping for air.
Bystanders, and even some doctors, sometimes hold off giving CPR (cardiopulmonary resuscitation) if a collapsed cardiac patient is still struggling to breathe. That could be a big mistake.
Cardiac arrest patients are more than five times more likely to survive if bystanders attempt resuscitation while the patient is still gasping, say Bentley J. Bobrow, MD, director of Arizona emergency medical services, and colleagues.
"Gasping is most frequent soon after collapse, and decreases with time," they note. "Bystander resuscitation efforts markedly improve survival in patients who are gasping from cardiac arrest."
Most people have been taught CPR techniques that alternate vigorous chest compressions with "breath of life" mouth-to-mouth ventilation. Bobrow's earlier work has questioned the value of mouth-to-mouth resuscitation, as it distracts rescuers from concentrating on the more important chest compressions.
And mouth-to-mouth resuscitation obviously is hard to perform on a person who is gasping -- a major reason why bystanders hesitate to resuscitate cardiac arrest patients who gasp.
Bobrow argues that rescuers should forget about mouth-to-mouth and focus on chest compressions. That means putting one's hands one atop the other over the patient's breastbone, locking one's elbows, and pressing down hard and rapidly until help arrives.
"When that person collapses, your hands are their heart," Bobrow told WebMD earlier this year. "If your hands are not on their chest, they have no heartbeat."
Bobrow's team analyzed records on 113 out-of-hospital cardiac arrest calls made in 2008 to the Phoenix Fire Department emergency dispatch center. In 39% of those calls, the patient had abnormal breathing.
Another analysis of 1,218 cardiac arrest patients treated by emergency medical services (EMS) found gasping was very common -- and that it most often happens soon after a patient collapses.
Among patients who had a cardiac arrest in the presence of EMS rescuers, 33% were gasping. If EMS arrived within seven minutes, 20% of patients were gasping; 14% were gasping when EMS arrived in seven to nine minutes, and only 7% were still gasping if EMS arrived more than nine minutes after the collapse.
Most importantly, 39% of cardiac arrest patients survived if treated while still gasping. Only 9% survived if they did not gasp when treated.
"The recognition and importance of gasping [after cardiac arrest] should be taught to bystanders and emergency medical dispatchers so as not to dissuade them from initiating prompt resuscitation efforts when appropriate," Bobrow and colleagues conclude.
The study appears in the Dec. 9 issue of the journal Circulation.