Study objective:

To discover the frequency of agonal respirations in cardiac arrest calls, the ways callers describe them, and discharge rates associated with agonal respirations.

Design:

We received taped recordings of calls reporting cardiac arrests and emergency medical technician and paramedic incident reports for 1991. Arrests after arrival of emergency medical services were excluded.

Setting:

King County, Washington, excluding the City of Seattle.

Participants:

Four hundred forty-five persons with out-of-hospital cardiac arrests receiving emergency medical services.

Interventions:

Telephone CPR, emergency medical technicians defibrillation, and advanced life support by paramedics.

Measurements and main results:

Any attempts at breathing described by callers were identified, as well as whether agonal respirations could be heard by dispatcher, emergency medical technicians, or paramedics. Agonal respirations occurred in 40% of 445 out-of-hospital cardiac arrests. Callers described agonal breathing in a variety of ways. Agonal respirations were present in 46% of arrests caused by cardiac etiology compared with 32% in other etiologies (p<.001) Fifty-five percent of witnessed arrests had agonal activity compared with 16% of unwitnessed arrests (p<.001) Agonal respirations occurred in 56% of arrests with a rhythm of ventricular fibrillation compared with 34% of cases with a nonventricular fibrillation rhythm (p<.001) Twenty-seven percent of patients with agonal respirations were discharged alive compared with 9% without them (p<.001).

Conclusion:

There is a high incidence of agonal activity associated with out-of-hospital cardiac arrest. Presence of agonal respirations is associated with increased survival. These findings have implications for public CPR training programs and emergency dispatcher telephone CPR programs.

References:

Clark JJ, Larsen MP, Culley LL, Graves JR, Eisenberg MS: Incidence of agonal respirations in sudden cardiac arrest. Ann Emerg Med December 1991;21:1464-1467.