This study aimed to evaluate whether gasping on cardiac arrest resuscitation by emergency medical services in transport was associated with a neurological outcome that is favorable for patients having undergone ECPR. In total, 166 patients who underwent ECPR were included in this study. During transportation by EMS, 38 patients exhibited gasping, whereas 128 patients did not. The patients who were observed to be gasping during the EMS transportation attained a favorable neurological outcome.

Out of hospital cardiac arrest (OHCA) is a major public health issue in developed countries, with about 120 thousand such events occurring in Japan annually, after which patient survival rate remains low. Furthermore, only up to 10% of patients could achieve a favorable neurological outcome, most likely due to insufficient cerebral blood flow. Resuscitation using extracorporeal membrane oxygenation (ECMO) was proposed to restore cerebral blood flow in the 1960s. However, it remains unknown whether gasping is a neurological prognostic factor for refractory cardiac arrest patients who fail to achieve ROSC by the usual resuscitation methods.

The present study shows that the patient’s gasping during transportation by EMS was independently associated with a favorable neurological outcome in patients undergoing ECPR. It is imperative to promote awareness of the potential significance of gasping. This can be achieved by informing EMS personnel and emergency physicians on the positive implications of gasping and not to abandon resuscitation efforts in such cases where the use of ECPR can save lives.