Article Data

  • Views 2266
  • Dowloads 187


Open Access

Gasping as a predictor of short- and long-term outcomes in patients with cardiac arrest: a systematic review and meta-analysis

  • Qin-Yue Guo1,2
  • Jing Xu2,3
  • Qin-Dong Shi1

1Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Street, Xi'an, 710061 Shaanxi, P. R. China

2Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA

3Department of Emergency Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Street, Xi'an, 710061 Shaanxi, P. R. China

DOI: 10.22514/sv.2021.006 Vol.17,Issue 2,March 2021 pp.208-213

Published: 08 March 2021

*Corresponding Author(s): Qin-Yue Guo E-mail:


Aims: Cardiac arrest (CA), a worldwide health problem in the public, has a high mortality rate. While gasping has been associated with increased survival and Return of Spontaneous Circulation (ROSC) after cardiac arrest in some studies, more data is needed.

Data sources: The literature on cardiac arrest and gasping from Medline, PubMed, Embase, Cochrane, and Web of Science up to September 2020 were searched, categorized, and analyzed. The association of CA and gasping outcomes were assessed by risk ratios (RR) and 95% confidence intervals (CI). Heterogeneity, sensitivity analysis, and publication bias was discussed.

Results: 8 studies from 7 articles were included. A fixed-effect or random-effect model was applied to all the outcomes using estimate pooled risk ratios (RR). Patients suffering gasping during CA were 2.08 times more likely to have return of spontaneous ROSC compared with patients without gasping (RR = 2.08, 95% CI: 1.93-2.25, P < 0.001). There was a significant increase in the survival to discharge rate of the patients who gasped (RR = 3.75, 95% CI = 3.27-4.29, P < 0.001); along with a more favorable neurological 1-year survival (RR = 8.02, 95% CI: 5.56, 11.57; P < 0.001) and the presence of a shockable cardiac rhythm (RR = 2.82, 95% CI: 2.50, 3.18; P < 0.001).

Conclusions: The presence of agonal respirations is positively associated with ROSC, achieving a shockable cardiac rhythm, increasing survival rate to discharge, and a neurologically favorable 1-year survival. Gasping may play an important role in cardiopulmonary resuscitation (CPR) training.


Gasping; Agonal respiration; Cardiac arrest; Cardiopulmonary resuscitation (CPR)

Cite and Share

Qin-Yue Guo,Jing Xu,Qin-Dong Shi. Gasping as a predictor of short- and long-term outcomes in patients with cardiac arrest: a systematic review and meta-analysis. Signa Vitae. 2021. 17(2);208-213.


[1] Nichol G, Thomas E, Callaway CW, Hedges J, Powell JL, Aufderheide TP, et al. Regional variation in out-of-hospital cardiac arrest incidence and outcome. Journal of the American Medical Association. 2008; 300: 1423-1431.

[2] Sasson C, Rogers MAM, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circulation: Cardiovascular Quality and Outcomes. 2010; 3: 63-81.

[3] Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart disease and stroke statistics-2017 update: a report from the american heart association. Circulation. 2017; 135: e146-e603.

[4] Dell’anna AM, Scolletta S, Donadello K, Taccone FS. Early neuropro-tection after cardiac arrest. Current Opinion in Critical Care. 2014; 20: 250-258.

[5] Clark JJ, Larsen MP, Culley LL, Graves JR, Eisenberg MS. Incidence of agonal respirations in sudden cardiac arrest. Annals of Emergency Medicine. 1992; 21: 1464-1467.

[6] Bobrow BJ, Zuercher M, Ewy GA, Clark L, Chikani V, Donahue D, et al. Gasping during cardiac arrest in humans is frequent and associated with improved survival. Circulation. 2008; 118: 2550-2554.

[7] Glossary on respiration and gas exchange. Journal of Applied Physiology. 1973; 34: 549-558.

[8] Yang L, Weil MH, Noc M, Tang W, Turner T, Gazmuri RJ. Spontaneous gasping increases the ability to resuscitate during experimental cardiopul-monary resuscitation. Critical Care Medicine. 1994; 22: 879-883.

[9] Yang L, Weil MH, Noc M, Turner T, Tang W. Spontaneous gasping during cardiac arrest. Critical Care Medicine. 1994; 22: A136.

[10] Xie J, Weil MH, Sun S, Yu T, Tang W. Spontaneous gasping generates cardiac output during cardiac arrest. Critical Care Medicine. 2004; 32: 238-240.

[11] Ristagno G, Tang W, Sun S, Weil MH. Spontaneous gasping produces carotid blood flow during untreated cardiac arrest. Resuscitation. 2007; 75: 366-371.

[12] Menegazzi JJ, Check BD. Spontaneous agonal respiration in a swine model of out-of-hospital cardiac arrest. Academic Emergency Medicine. 1995; 2: 1053-1056.

[13] Zuercher M, Ewy GA, Otto CW, Hilwig RW, Bobrow BJ, Clark L, et al. Gasping in response to basic resuscitation efforts: observation in a swine model of cardiac arrest. Critical Care Research and Practice. 2010; 2010: 351638.

[14] Srinivasan V, Nadkarni VM, Yannopoulos D, Marino BS, Sigurdsson G, McKnite SH, et al. Spontaneous gasping decreases intracranial pressure and improves cerebral perfusion in a pig model of ventricular fibrillation. Resuscitation. 2006; 69: 329-334.

[15] Wolfskeil M, Vanwulpen M, Duchatelet C, Monsieurs KG, Hachimi-Idrissi S. Detection and quantification of gasping during resuscitation for out-of-hospital cardiac arrest. Resuscitation. 2017; 117: 40-45.

[16] Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Ottawa Health Research Institute. 2012.

[17] Takei Y, Tanaka Y, Maeda T, Ohta K, Inaba H. Agonal breathing without carotid pulse on EMS arrival but not agonal breathing with carotid pulse is associated with better outcomes of out-of-hospital respiratory and cardiac arrests. Resuscitation. 2017; 118: e70.

[18] Martens P, Mullie A, Vanhaute O. Clinical status before and during cardiopulmonary resuscitation versus outcome in two consecutive databases. European Journal of Emergency Medicine. 1995; 2: 17-23.

[19] Inaba H, Takei Y, Kamikura T, Funada A, Wato Y, Sakagami S, et al. Agonal respiration with and without carotid pulsation on emergency medical technician’s arrival at patient. Circulation. 2015; 132: A14300.

[20] Marengo L, Ummenhofer W, Pascal G, Harm F, Lüthy M, Zürcher M. Abstract 17847: gasping is a valid predictor of ROSC and hospital discharge for in-hospital cardiac arrest occurring on the ward. Circulation. 2015; 132: A17847.

[21] Debaty G, Labarere J, Frascone RJ, Wayne MA, Swor RA, Mahoney BD, et al. Long-term prognostic value of gasping during out-of-hospital cardiac arrest. Journal of the American College of Cardiology. 2017; 70: 1467-1476.

[22] Grundmann S, Busch HJ. Neurologic prognosis after cardiac arrest. The New England Journal of Medicine. 2009; 361: 1999.

[23] SOS-KANTO study group. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. The Lancet. 2007; 369: 920-926.

[24] Pernat A, Weil M, Bisera J, Tang W, Fukui M. Spontaneous gasping maintains more optimal amplitudes of ventricular fibrillation waveforms during cardiac arrest. USA: Lippincott Williams & Wilkins 227 East Washington SQ, Philadelphia, PA. 1998.

[25] Gozal D, Torres JE, Gozal YM, Nuckton TJ. Characterization and developmental aspects of anoxia-induced gasping in the rat. Neonatology. 1996; 70: 280-288.

[26] St.-John WM, Paton JFR. Role of pontile mechanisms in the neurogenesis of eupnea. Respiratory Physiology & Neurobiology. 2004; 143: 321-332.

[27] St-John WM, Paton JFR. Respiratory-modulated neuronal activities of the rostral medulla which may generate gasping. Respiratory Physiology & Neurobiology. 2003; 135: 97-101.

[28] Sridhar R, Thach BT, Kelly DH, Henslee JA. Characterization of successful and failed autoresuscitation in human infants, including those dying of SIDS. Pediatric Pulmonology. 2003; 36: 113-122.

[29] Franek O, Sukopova P. Laypersons are not able to recognize cardiac arrest when “gasping” is present. Resuscitation. 2008; 77: S46-S47.

[30] Chęciński I, Zyśko D, Smereka J, Gajek J, Mirecka-Świerzko J, Ściborski R, et al. The presence of agonal respiration during cardiac arrest and resuscitation attempts by witnesses. Clinical and Experimental Medicine. 2011; 20: 761-765.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time