Gasping, Survival, and the Science of Resuscitation

The study in the current issue of Circulation by Bobrow et al1 is important for a multitude of reasons. This study revolves around the concept of “gasping” as it relates to cardiac arrest. The study questions both the incidence of gasping and its impact on and relationship to survival in patients who suffer out-of-hospital cardiac arrest (OHCA).Article p 2550 The authors demonstrate that gasping after cardiac arrest is common, that it is most frequent soon after cardiac arrest, and that its frequency decreases over time. Additionally, the presence of gasping is associated with an increased survival to discharge from the hospital. It is interesting to note that the survival rate was not necessarily related to the institution of bystander cardiopulmonary resuscitation (CPR) because the same percentage of “gaspers” and “nongaspers” received bystander CPR. Yet among the gaspers, the authors found a 39% survival rate versus only a 9% survival rate in the nongaspers.Although the true incidence of gasping after cardiac arrest is unclear, more perplexing is the question, what is the cause of the ostensible protective benefit of gasping? Equally important, as the authors point out, is that first responders and medical professionals recognize gasping as a symptom of cardiac arrest and institute CPR immediately rather than confuse it with normal breathing and thereby delay CPR.Previous experimental work exists with regard to gasping and cardiac arrest. Xie et al2 studied the effects of gasping during untreated ventricular fibrillation in an animal model, showing that gasping during ventricular fibrillation increased both ventilation and cardiac output during cardiac arrest. Srinivasan et al3 studied the effects of gasping in a pig model of ventricular fibrillation and showed that spontaneous gasping decreased intracranial pressure and increased cerebral perfusion pressure. The article by Srinivasan and colleagues thus provides a …