Gasping as a predictor of short- and long-term outcomes in patients with cardiac arrest: a systematic review and meta-analysis

Aims: Cardiac arrest (CA), a worldwide health problem in the public, has a high mortality rate. While gasping has been associated with increased survival and Return of Spontaneous Circulation (ROSC) after cardiac arrest in some studies, more data is needed.

Data sources: The literature on cardiac arrest and gasping from Medline, PubMed, Embase, Cochrane, and Web of Science up to September 2020 were searched, categorized, and analyzed. The association of CA and gasping outcomes were assessed by risk ratios (RR) and 95% confidence intervals (CI). Heterogeneity, sensitivity analysis, and publication bias was discussed.

Results: 8 studies from 7 articles were included. A fixed-effect or random-effect model was applied to all the outcomes using estimate pooled risk ratios (RR). Patients suffering gasping during CA were 2.08 times more likely to have return of spontaneous ROSC compared with patients without gasping (RR = 2.08, 95% CI: 1.93-2.25, P < 0.001). There was a significant increase in the survival to discharge rate of the patients who gasped (RR = 3.75, 95% CI = 3.27-4.29, P < 0.001); along with a more favorable neurological 1-year survival (RR = 8.02, 95% CI: 5.56, 11.57; P < 0.001) and the presence of a shockable cardiac rhythm (RR = 2.82, 95% CI: 2.50, 3.18; P < 0.001).

Conclusions: The presence of agonal respirations is positively associated with ROSC, achieving a shockable cardiac rhythm, increasing survival rate to discharge, and a neurologically favorable 1-year survival. Gasping may play an important role in cardiopulmonary resuscitation (CPR) training.

Gasping; Agonal respiration; Cardiac arrest; Cardiopulmonary resuscitation (CPR)

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