Abstract 14300: Agonal Respiration With and Without Carotid Pulsation on Emergency Medical Technician’s Arrival at Patient

Abstract

Aim: To determine the association between agonal respirations with and without carotid pulsation and neurologically favorable one-year survival from OHCAs. Methods and Results: Data for resuscitation-attempted, 7,048 OHCAs were prospectively collected during the period of 2007-2013 in Ishikawa Prefecture. Of these, 6,600 cases were in deep coma, and had agonal respiration (N = 238) or no respiration (N = 6,362). Carotid pulse was present in 26 (10.9%) of 238 cases with agonal respiration, and in 34 (0.5%) of 6,382 cases with no respiration (respiratory arrest cases in the narrow sense). The rate of neurologically favorable one-year survival in the agonal respiration with pulse, agonal respiration without pulse, no respiration with pulse, no respiration without pulse groups was 15.4% (4/26), 21.7% (46/212), 14.7% (5/34), and 2.3% (143/6328), respectively. Interaction test for survival disclosed a significant interaction between respiration and pulsation (p = 0.002). Agonal breathing was strongly associated with shockable initial rhythm (OR; 95% CI, 3.73; 2.66-5.23) and neurologically favorable one-year survival (12.0; 8.3-17.3) only when pulse was absent on EMT arrival at patients (Table). The survival rate was extremely high [56.3% (27/48)] when initial rhythm was shockable and when agonal respiration was observed. Conclusions: Carotid pulse was present in some (11%) of OHCA patients with agonal respiration on ENT arrival at patients, indicating that chest compressions may be initiated before “true” cardiac arrest in adherence to current BLS guidelines. Agonal respiration was associated with neurologically favorable survival from OHCAs only when carotid pulse was absent on EMT arrival at patients.