26 The influence of agonal breathing on call-taker recognition of out-of-hospital cardiac arrest

Aim Call-taker recognition of out-of-hospital cardiac arrest (OHCA) contributes significantly to patient survival, through reduced response time and dispatch-assisted cardiopulmonary resuscitation. A potential barrier to OHCA recognition is agonal breathing, whereby patients are often described as breathing. Our aim was to determine the role of agonal breathing in non-recognition, and delayed recognition, of OHCA. Method We analysed cases of non-traumatic OHCA where paramedics performed resuscitation, in Perth, Australia in 2014–2015. Calls in this system were processed using the Medical Priority Dispatch System. We excluded cases where the patient was clearly alive during the call. Listening to calls, we categorised answers to the question ‘Is s/he breathing?’ as ‘No’, ‘Agonal/Ineffective’, ‘Unsure’ or ‘Yes’. These data were compared to OHCA recognition, as determined from computer aided dispatch data. Results Among 902 OHCA cases, 87% (782/902) were recognised as OHCA by call-takers. In total, 21% of calls (193/902) had answers consistent with agonal breathing (e.g. ‘gasping’, ‘only just’). However, such calls comprised 38% (46/120) of the cases not recognised as OHCA, and 45% (112/250) of the cases of delayed recognition (recognised after initial ambulance dispatch). Only 18% (35/193) of cases with agonal descriptions were recognised as OHCA at initial dispatch. Conclusion Calls with descriptions of agonal breathing comprise a large proportion of cases that are either not recognised as OHCA or have delayed recognition. Call-taker response to caller descriptions of agonal breathing remains a major opportunity for improved OHCA recognition. Conflict of interest A Whiteside, P Bailey and J Finn receive salary support from St John Ambulance Western Australia. Funding Funding for this research was received from an NHMRC (Australian National Health and Medical Research Council) Partnership Project: APP1076949 ‘Improving ambulance dispatch to time-critical emergencies’.