By Nathan Harig
SAN DIEGO — Gasping patients in cardiac arrest tend to have better outcomes. This research finding was shared by Dr. Gordon Ewy at the Emergency Cardiovascular Care Update 2015.
Ewy, winner of the Hans Dahll Award, pioneered Arizona’s transition from standard CPR, which focuses care on the heart and lungs, to New CPR, which is also known as cardiocerebral resuscitation and focuses treatment on the heart and brain.
According to Ewy, while breathing comes from the brain, gasping comes from the brainstem. For patients in v-fib cardiac arrest, gasping starts around the two-minute mark, crescendoing in frequency, and then decrescendoing until stopping about five minutes into an arrest.
For patients who had witnessed arrests, 55 percent were found to be gasping by their rescuer. In non-witnessed v-fib arrests, this number dropped to 16 percent. Early recognition of arrest and intervention was critical in resuscitating patients.
Ewy stressed this finding in the context of encouraging bystanders and rescuers to practice hands-only or compression-only CPR, which helps Myocardial Perfusion Pressure and in turn helps resuscitate the brain of a patient in primary cardiac arrest.
Patients with witnessed v-fib receiving compression-only CPR were more likely to continually gasp or start to gasp spontaneously. Of those who gasped, 39 percent were found to survive, while only 9 percent of the non-gasping patients had a positive outcome.
Memorable quotes on cardiac arrest and CPR:
- “Unfortunately, the first sign of cardiovascular disease is often the last. The first (sign) is often sudden cardiac death.”
- “Why new CPR? In spite of standards published in 1970, more standards, then guidelines, and then updates of guidelines; survival rates averaged 7.6 percent and were unchanged from 1978 until 2008.”
- “It’s not the pH, it’s not the O2 content, it is the Myocardial Perfusion Pressure.”
Key Takeaways to improve survival with improved bystander CPR:
Here are three key takeaways from Ewy’s presentation to improve survival from out of hospital cardiac arrest.
1. Quick recognition of cardiac arrest
Quick recognition by dispatchers that an unconscious gasping patient may be in cardiac arrest is critical. The cardiac chain of survival, according to Ewy, is only as strong as its weakest link. Without early CPR, the likelihood that a patient will be resuscitated drops significantly. Ewy found a 5 percent reduction in resuscitation probability for each minute of delay in starting compressions.
2. Compression-only CPR improves willingness of bystanders to act
Only one in four bystanders are willing to perform CPR due to the perception of having to give mouth-to-mouth breathing. By removing this barrier, Ewy believes the willingness to perform compression-only CPR is increased. Advocacy for bystander CPR, Ewy reminded the audience, came of age the same time as the HIV epidemic, which caused many people to avoid contact with a stranger.
3. Practices to improve bystander CPR
Strategies to increase bystander CPR in Tuscon, Arizona, included sending compression-only CPR kits to every 6th through 12th grade school and adding a flyer stressing how simple and beneficial compression-only CPR was in residential utility bills. Newspaper ads and celebrity endorsements also helped to get the message out that breathing (ventilating the patient) wasn’t necessary, which Ewy believed was critical in getting behaviors to change.
Finally, while compression-only CPR and cardiocerebral resuscitation is advocated for patients in primary cardiac arrest, especially where an arrest is unwitnessed and involves non-normal breathing. Ewy advised that traditional CPR is still most useful for patients with respiratory-related arrests.
About the author
Nathan Harig is the Assistant Chief of Administration at Cumberland Goodwill EMS in Carlisle,