Association between gasping and survival among out-of-hospital cardiac arrest patients undergoing extracorporeal cardiopulmonary resuscitation: The SOS-KANTO 2017 study

Makoto Aoki; Shotaro Aso; Yohei Okada; Akira Kawauchi; Tomoko Ogasawara; Takashi Tagami; Yusuke Sawada; Hideo Yasunaga; Nobuya Kitamura; Kiyohiro Oshima; SOS-KANTO 2017 Study Group

doi:10.1016/j.resplu.2024.100622

Association between gasping and survival among out-of-hospital cardiac arrest patients undergoing extracorporeal cardiopulmonary resuscitation: The SOS-KANTO 2017 study

Resusc Plus. 2024 Mar 30:18:100622. doi: 10.1016/j.resplu.2024.100622. eCollection 2024 Jun.

Authors

Affiliations

¹ Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Gunma, Japan.
² Division of Traumatology, Research Institute, National Defense Medical College, Saitama, Japan.
³ Department of Real World Evidence, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
⁴ Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
⁵ Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
⁶ Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan.
⁷ Department of Emergency Medicine, Gunma University Graduate School of Medicine, Gunma, Japan.
⁸ Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan.
⁹ Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Chiba Japan.

Abstract

Aim: This study aimed to assess the association between gasping and survival among out-of-hospital cardiac arrest (OHCA) patients requiring extracorporeal cardiopulmonary resuscitation (ECPR).

Methods: This prospective, multicenter, observational study was conducted between 2019 and 2021. We categorized adult patients requiring ECPR into those with or without gasping prior to hospital arrival. The primary outcome was the 30-day survival. We performed multivariable logistic regression analyses fitted with generalized estimating equations and subgroup analyses based on the initial rhythm and age.

Results: Of the 9,909 patients with OHCA requiring ECPR, 332 were enrolled in the present study, including 92 (27.7%) and 240 (72.3%) with and without gasping, respectively. The 30-day survival was higher in patients with gasping than in those without gasping (35.9% [33/92] vs. 16.2% [39/240]). In the logistic regression analysis, gasping was significantly associated with improved 30-day survival (adjusted odds ratio: 3.01; 95% confidence interval, 1.64-5.51). Subgroup analyses demonstrated similar trends in patients with an initial non-shockable rhythm and older age.

Conclusions: Gasping was associated with improved survival in OHCA patients requiring ECPR, even those with an initial non-shockable rhythm and older age. Clinicians may select the candidates for ECPR appropriately based on the presence of gasping.

Keywords: Cardiopulmonary resuscitation; Extracorporeal cardiopulmonary resuscitation; Gasping; Out-of-hospital cardiac arrest; Sign of life.