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

Guillaume Debaty, Jose Labarere, Ralph J. Frascone, Marvin A. Wayne, Robert A. Swor, Brian D. Mahoney, Robert M. Domeier, Michael L. Olinger, Brian J. O'Neil, Demetris Yannopoulos, Tom P. Aufderheide, Keith G. Lurie

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14 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1467-1476
Number of pages10
JournalJournal of the American College of Cardiology
Issue number12
StatePublished - Sep 19 2017


  • agonal breathing
  • cardiac arrest
  • cardiopulmonary resuscitation
  • gasping

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Debaty, G., Labarere, J., Frascone, R. J., Wayne, M. A., Swor, R. A., Mahoney, B. D., Domeier, R. M., Olinger, M. L., O'Neil, B. J., Yannopoulos, D., Aufderheide, T. P., & Lurie, K. G. (2017). Long-Term Prognostic Value of Gasping During Out-of-Hospital Cardiac Arrest. Journal of the American College of Cardiology, 70(12), 1467-1476. https://doi.org/10.1016/j.jacc.2017.07.782