TORONTO - When someone collapses with a cardiac arrest, a bystander should not mistake gasping for breathing and should begin chest compressions immediately, a new study urges.
The research was conducted in Arizona and looked at survival rates, as well as how often people made gasping or gurgling, moaning or snorting noises after they collapsed with a cardiac arrest.
But it's an issue in Canada too. Dr. Andrew Travers, a spokesman for the Heart and Stroke Foundation of Canada, said it's a problem when people misinterpret gasping for breathing.
"The danger is that they won't do anything when they should be doing something, like chest compressions," he said from Halifax.
"And unfortunately, it's not just the bystanders out in the community. There's been cases reported where even targeted health-care responders like a physician or a nurse wouldn't initiate chest compressions because they thought the patient was breathing. But again, confusing gasping with breathing."
The paper by the Resuscitation Research Group at the University of Arizona Sarver Heart Center was published Monday in the online issue of Circulation, the official journal of the American Heart Association.
"You'll find out in our study that if you're doing CPR and they're gasping, the survival rate is 39 per cent. If you're doing CPR and they're not gasping, the survival rate is nine per cent," one of the authors, Dr. Gordon Ewy, director of the heart centre, said in a telephone interview.
"And that probably relates to the fact that if they're not gasping, you started too late."
The study involved an analysis of out-of-hospital cardiac arrests from Phoenix fire department files to determine the presence of gasping, and found it in 39 per cent of cases. The researchers also analyzed the cases of 1,218 cardiac arrest patients in Arizona documented in emergency medical system reports in relation to EMS arrival times.
Travers said the study is the first one that looks at the issue in a well-structured way.
"The sample size is really quite big. And it gives quite a clarity to the incidence, or basically how often gasping actually takes place."
The researchers studied whether patients were gasping while medical dispatchers were on the phone with a caller, then tracked whether gasping was still occurring when paramedics arrived.
"What we found was it declined rapidly and that if paramedics got there, for example, after 10 minutes, very few people were gasping," said Dr. Bentley Bobraw, first author of the paper.
"But if they got there early on, then many people were gasping."
Ewy said it's something that needs to be part of the dynamic when dispatchers start asking questions when someone calls in an emergency.
When the dispatcher asks if someone is breathing, the caller might mistakenly respond in the affirmative even when the person is only gasping, not breathing.
"So the dispatcher says `roll them over on their side so they won't aspirate if they vomit,' and etcetera. So then two or three minutes later, they stop breathing, they call back and say `he's not breathing anymore.' So then they send the paramedics."
"That delays the paramedic response. The longer it takes the paramedics to get there, the less the chance of survival."
More important, he said, it may delay the bystander from doing chest compressions, which is one of the major determinants of survival.
Dr. Ian Stiell, a professor and chair of emergency medicine at the University of Ottawa, welcomed the study.
"I've been preaching about CPR for years, but it's a hard message to get out there, partly because people are too busy to get out there and take a course," he said from Ottawa, where he's a senior scientist at Ottawa Health Research Institute.
"It's older folks who need to take the course because it's their spouse who might collapse. The typical cardiac arrest patient is almost 70."
He said his family watched a CPR training DVD from the Heart and Stroke Foundation on the weekend, and it devoted a couple sentences to the gasping issue.
"I think it's newly becoming part of courses, and it's in the most recent guidelines," he said.
"I'm not sure how much it's being emphasized. It is mentioned, and probably should be emphasized even more for bystander folks."
