Description of Abnormal Breathing Is Associated With Improved Outcomes and Delayed Telephone Cardiopulmonary Resuscitation Instructions

Abstract

BackgroundEmergency 9‐1‐1 callers use a wide range of terms to describe abnormal breathing in persons with out‐of‐hospital cardiac arrest (OHCA). These breathing descriptors can obstruct the telephone cardiopulmonary resuscitation (CPR) process.Methods and ResultsWe conducted an observational study of emergency call audio recordings linked to confirmed OHCAs in a statewide Utstein‐style database. Breathing descriptors fell into 1 of 8 groups (eg, gasping, snoring). We divided the study population into groups with and without descriptors for abnormal breathing to investigate the impact of these descriptors on patient outcomes and telephone CPR process. Callers used descriptors in 459 of 2411 cases (19.0%) between October 1, 2010, and December 31, 2014. Survival outcome was better when the caller used a breathing descriptor (19.6% versus 8.8%, P<0.0001), with an odds ratio of 1.63 (95% confidence interval, 1.17–2.25). After exclusions, 379 of 459 cases were eligible for process analysis. When callers described abnormal breathing, the rates of telecommunicator OHCA recognition, CPR instruction, and telephone CPR were lower than when callers did not use a breathing descriptor (79.7% versus 93.0%, P<0.0001; 65.4% versus 72.5%, P=0.0078; and 60.2% versus 66.9%, P=0.0123, respectively). The time interval between call receipt and OHCA recognition was longer when the caller used a breathing descriptor (118.5 versus 73.5 seconds, P<0.0001).ConclusionsDescriptors of abnormal breathing are associated with improved outcomes but also with delays in the identification of OHCA. Familiarizing telecommunicators with these descriptors may improve the telephone CPR process including OHCA recognition for patients with increased probability of survival.

Adult Basic Life Support

“…Negative likelihood ratio = the likelihood of a patient with confirmed cardiac arrest to be labeled negative compared with a person without cardiac arrest (the smaller the likelihood ratio, the better the test to rule out cardiac arrest). * 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 . †Patients strictly with confirmed OHCA.…”

<p>Telephone CPR: Current Status, Challenges, and Future Perspectives</p>

“…Callers also describe this form of abnormal breathing as: gasping, snoring, or moaning. 15 , 28 Descriptors for agonal respirations often vary depending on the culture or language. Each local agency should investigate how lay people in the community are likely to describe agonal respiration and try to improve CA identification based on these results.…”

“… 12 , 45 , 71 , 72 Studies reported that time from call receipt to dispatch CA identification and start of CPR instruction is approximately 60 and 150 seconds. 28 , 32 , 45 The time from the bystander initiating the call to the first chest compression also varies widely. It is reported to be 180 seconds to over 5 minutes.…”

“…It is reported to be 180 seconds to over 5 minutes. 28 , 32 , 45 , 72 Assessing and improving local TCPR with these clearly measurable metrics will contribute to a high-performance TCPR and an improved CA survival rate.…”

Improving Community Survival Rates from Out-of-Hospital Cardiac Arrest

“…Gasping or agonal breathing is not “normal breathing” but rather an abrupt, often forceful inspiration and occurs only a few times per minute. Laypersons can mistake this primitive respiratory reflex as “snoring, snorting, moaning, or difficulty in breathing”, and not realize that the patient has suffered a cardiac arrest [7-10].…”