Abstract
Gasping is supposed to be easily recognisable sign of cardiac arrest by typical breathing pattern. We present a 56-year-old man with out-of-hospital cardiac arrest with atypical gasping.
Cardiopulmonary resuscitation was started by a lay rescuer using telephone-assisted CPR. On arrival of the rescue team, the patient was gasping with typical inspiration/expiration ratio at high frequency 24/min.
Ventricular fibrillation was detected. The first defibrillation shock (200 J) resulted in return of spontaneous circulation.
The patient continued with abnormal breathing pattern on a Venti-mask with oxygen supply 8 l/min. After next 2 minutes, ventricular fibrillation returned.
A second defibrillation shock (200 J) was performed without ROSC. A third defibrillation shock (200 J) was delivered after 2 minutes with continuing chest compressions and high frequency gasping resulting in definitive ROSC.
After ROSC, the patient's BP was 102/83 mmHg, pulse 124/min, SpO2 100% using a Venti-mask with an 8 l/min oxygen flow. The total time from OHCA to ROSC was 12 minutes.
Fentanyl 0,1 mg was administered i.v. The patient had abnormal breathing pattern with high frequency for several minutes after ROSC, then the pattern returned to normal inspiration: expiration ratio with frequency 18/min.
Complete amnesia on the event lasted 3 hours. Based on the literature review, we must conclude that there are insufficient data to recommend when to leave gasping as the sole modeof ventilation during resuscitation in patients with cardiac arrest.
This case report describes an abnormal agonal breathing pattern during CPR.