Long-Term Prognostic Value of Gasping During Out-of-Hospital Cardiac Arrest

Debaty, Guillaume; Labarère, José; Frascone, Ralph J.; Wayne, Michael; Swor, Robert A.; Mahoney, Brian D.; Domeier, Robert M.; Olinger, Michael; O’Neil, Brian J.; Yannopoulos, Demetris; Aufderheide, Tom P.; Lurie, Keith G.

doi:10.1016/j.jacc.2017.07.782

Cited by 52 publications

(37 citation statements)

References 25 publications

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“…However, the evaluation of potential for brain function recovery during CPR is further challenging. There are some promising physiological parameters such as presence of agonal breathing [28], regional cerebral oxygen saturation [29], and quantitative pupillometry [30] that have been reported to be associated with the neurological outcome and might indicate the residual function of the brain. These diagnostic methods and neurological physiological parameters during CPR should be investigated in future studies to establish the appropriate indication criteria for ECPR beyond the initial rhythm and to improve the effectiveness of ECPR.…”

Section: Discussionmentioning

confidence: 99%

Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study

Tanimoto

Sugiyama

Tanabe

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory out-of-hospital cardiac arrest (OHCA). Most studies evaluating the effectiveness of ECPR include patients with an initial shockable rhythm. However, the effectiveness of ECPR for patients with an initial non-shockable rhythm remains unknown. This retrospective single-center study aimed to evaluate the effectiveness of ECPR for patients with an initial non-shockable rhythm, with reference to the outcomes of OHCA patients with an initial shockable rhythm. Methods Adult OHCA patients treated with ECPR at our center during 2011–2018 were included in the study. Patients were classified into the initial shockable rhythm group and the non-shockable rhythm group. The primary outcome was the cerebral performance category (CPC) scale score at hospital discharge. A CPC score of 1 or 2 was defined as a good outcome. Results In total, 186 patients were eligible. Among them, 124 had an initial shockable rhythm and 62 had an initial non-shockable rhythm. Among all patients, 158 (85%) were male, with a median age of 59 (interquartile range [IQR], 48–65) years, and the median low flow time was 41 (IQR, 33–48) min. Collapse was witnessed in 169 (91%) patients, and 36 (19%) achieved return of spontaneous circulation (ROSC) transiently. Proportion of female patients, presence of bystander cardiopulmonary resuscitation, and collapse after the arrival of emergency medical service personnel were significantly higher in the non-shockable rhythm group. The rate of good outcomes at hospital discharge was not significantly different between the shockable and non-shockable groups (19% vs. 16%, p = 0.69). Initial shockable rhythm was not significantly associated with good outcome after controlling for potential confounders (adjusted odds ratio 1.58, 95% confidence interval: 0.66–3.81, p = 0.31). In the non-shockable group, patients with good outcomes had a higher rate of transient ROSC, and pulmonary embolism was the leading etiology. Conclusions The outcomes of patients with an initial non-shockable rhythm are comparable with those having an initial shockable rhythm. OHCA patients with an initial non-shockable rhythm could be candidates for ECPR, if they are presumed to have reversible etiology and potential for good neurological recovery.

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Section: Discussionmentioning

confidence: 99%

Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study

Tanimoto

Sugiyama

Tanabe

et al. 2020

Scand J Trauma Resusc Emerg Med

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“…In the first minutes after CA patients may have abnormal brainstem mediated breathing, commonly referred to as "agonal breathing". Prospective studies have reported agonal breathing in about a third of witnessed out-of-hospital cardiac arrests (OHCA), and found it to be associated with improved survival [6]. This phenomenon has also been observed in animal experimental studies, where this agonal respiration has been shown to produce both forward blood flow and ventilation [7].…”

Section: Changes In Oxygen and Carbon Dioxide In Cardiac Arrestmentioning

confidence: 90%

Oxygen and carbon dioxide targets during and after resuscitation of cardiac arrest patients

2018

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“…As mentioned above, in the setting of preserving agonal respiration, the chances of achieving a favorable neurological outcome seem to be higher with agonal respiration than without it, even in cases of non‐shockable cardiac arrest . Extracorporeal membrane oxygenation produces definite systemic blood flow.…”

Section: Discussionmentioning

confidence: 99%

“…Agonal respiration appears to be a natural biomarker for the presence of brainstem activity, predicting the preservation of neurological function and possible favorable neurological outcomes in patients with cardiac arrest . Agonal respiration also facilitates respiratory gas exchange, increasing aortic, coronary, and cerebral perfusions, resulting in favorable neurological outcomes in patients with cardiac arrest.…”

Section: Introductionmentioning

confidence: 99%

The prognostic value of agonal respiration in refractory cardiac arrest: a case series of non‐shockable cardiac arrest successfully resuscitated through extracorporeal cardiopulmonary resuscitation

Bunya

Wada

Yamaoka

et al. 2019

Acute Medicine & Surgery

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Background Agonal respiration following out‐of‐hospital cardiac arrest is associated with favorable neurological outcomes. Resuscitation using extracorporeal membrane oxygenation could contribute to achieving favorable neurological outcomes in patients with refractory cardiac arrest. Case presentation We report two cases of refractory cardiac arrest with non‐shockable rhythms and agonal respiration; both patients were successfully resuscitated through extracorporeal cardiopulmonary resuscitation (ECPR). Both patients were breathing spontaneously upon arrival. One patient was asystolic and the other experienced pulseless electrical activity followed by ventricular fibrillation. Agonal respiration was observed in both and ECPR was implemented, leading to a favorable neurological outcome at discharge. Conclusion The presence of agonal respiration has the potential to confer a favorable neurological outcome in patients with refractory cardiac arrest if maintained, even when the initial cardiac rhythm is not shockable. In these cases, resuscitation should not be abandoned, and ECPR should be considered.

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Long-Term Prognostic Value of Gasping During Out-of-Hospital Cardiac Arrest

Cited by 52 publications

References 25 publications

Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study

Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study

Oxygen and carbon dioxide targets during and after resuscitation of cardiac arrest patients

The prognostic value of agonal respiration in refractory cardiac arrest: a case series of non‐shockable cardiac arrest successfully resuscitated through extracorporeal cardiopulmonary resuscitation

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