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.

中文翻译：

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院外心脏骤停期间喘气的长期预后价值

背景喘气是在心肺复苏(CPR)期间增强氧合和循环的自然反射。目的 本研究旨在评估院外心脏骤停期间的喘息与 1 年生存率和良好的神经学结果之间的关系。方法 作者前瞻性地收集了 2007 年 8 月至 2009 年 7 月间美国国立卫生研究院资助的院外心脏骤停临床试验中所有可评估受试者的喘气发生率。喘气与 1 年间的关系使用多变量逻辑回归估计具有良好神经功能的存活率，定义为脑功能分类 (CPC) 评分≤2。结果 CPC 评分≤2 的 1 年生存率为 5.4%（1,827 人中的 98 人），心肺复苏期间有和没有自发性喘气或濒死呼吸的个体分别为 20%（177 人中的 36 人）和 3.7％（1,643 人中的 61 人）。在多变量分析中，CPC ≤ 2 的 1 年生存率与年轻独立相关（1 SD 增量的比值比 [OR] 0.57；95% 置信区间 [CI]：0.43 至 0.76）、CPR 期间喘气（OR：3.94 ；95% CI：2.09 至 7.44），可电击的初始记录节律（OR：16.50；95% CI：7.40 至 36.81），CPR 持续时间较短（OR：0.31；95% CI：0.19 至 0.51），或较低的肾上腺素剂量（OR：16.50；95% CI：7.40 至 36.81） ：0.47；95% CI：0.25 至 0.87）和肺水肿（OR：3.41；95% CI：1.53 至 7.60）。喘息与可电击的初始记录节律相结合，CPC ≤2 的 1 年生存率的 OR（95% CI：23.49 至 136.92）比无喘气和无可电击节律高 57 倍。结论 CPR 期间喘气与 CPC ≤ 2 的 1 年生存率增加独立相关，无论首次记录的节律如何。这些发现强调了在喘息患者中不要过早终止复苏的重要性，以及在所有未来的心脏骤停试验和登记中常规识别、监测和记录喘息数据的必要性。