803
KAZUISTIKA4321202011157120176236269319376408468532
/4878202011133
CASE4936202011155117168223
REPORT5184202011157113168230289344
Uncommon28603230975296133177244312356402
presentation32793230974572113145186231258297324343388433
of37293230974468
gasping38143230974584116162181226272
during41033230974589116135180226
ventricular43463230973878123150177196233277297336362
fibrillation4725323097214288115135154173212239258303348
–509032309740
case51473230973675107148
report53123230972667113159186215
|5584198011126
173565419801113676124
/23688043010732
Anest24458043010752100145178207
intenziv267280430107196794136184221240282
Med.29738043010770115165181
2023;34(4):172-1753173804301074487129173186231275300341363377414451494520558595636
/38548043010732
ANESTEZIOLOGIE39528043010752111155200245290341362424467526586607650
A46248043010752
INTENZIVNÍ4698804301071978123168226276296344405426
MEDICÍNA51458043010770114173195248268327381
www.aimjournal.cz4258043010765133201214257275349367415463490539579598614654693
Fig.3047476001255687137164
3.3227476001255479
ECG3351477501074087137
rhythm3504477501072672107136182253
after377347750107456897134159
the3948477501072773111
second4075477501073169106149196241
defibrillation4333477501074583106125170196214233251296322340385432
shock4781477501073176121159196
Fig.3053403201255687137164
2.3233403201255481
ECG3359404601074087137
rhythm3512404601072672107136182253
after378140460107456897134159
the3956404601072773111
first40834046010723426799125
defibrillation4224404601074583107126171197215233251296322340385432
shock4672404601073176121160196
Fig.3053546001255687137164
4.3233546001255481
ECG3359547501074087137
rhythm3512547501072672107136182253
after378154750107456897134159
the3956547501072773111
a40835475010745
third414554750107267290115159
defibrillation4320547501074583107125171197215233251296322340385432
shock4768547501073176121159196
Fig.3053613101255687137164
5.3233613101255478
12-lead3357614601074276101121159204250
ECG3623614601074087137
before3776614601074584107151177214
the4006614601072773111
transfer413361460107265294141170193231256
to4406614601072670
the4492614601072672110
hospital4618614601074792122166185211254272
Fig.3054319901255687137164
1.3234319901255478
Initial335732130107196583109127172190
ECG3563321301074088137
rhythm3716321301072672108136182253
Introduction425587015340115166227293365436493547587653726
In42576301071967
the51976301072876121
period66376301075093117133179227
immediately91176301071889161202250266304328368385423
after13557630107416291131155
cardiac153176301074079103149165202241
arrest,17937630107416489130161187201
there201576301072874115139180
is221676301071949
a2286763010741
gradual234876301074973112159204242259
arrest26287630107416489130161187
of283676301074870
spontaneous42590301073480127173197236282323370416446
breathing89290301075074115152177223239284331
activity124490301074179107123161178204244
within150990301076582107153169214
seconds174490301073476114158204251282
to204790301072872
minutes214090301077490135180206246277
followed24389030107246986102147210251298
by275790301075087
a2865903010741
period425104301074991115131176223
of660104301074768
agonal740104301074087132178215231
or982104301074872
terminal106510430107286891162178223261277
breathing1353104301074973113151175220236281327
or1691104301074872
gasping1774104301074986117163179224270
in2056104301071863
some2130104301073479150191
patients.2333104301074988112128169214238270283
Gasping2628104301075694124170187232278
is425118301071951
associated498118301074274106153193210249275316365
with886118301076684110158
probability1066118301075176122172212261278295312338380
of1468118301074972
a15621183010742
shockable1626118301073585136180220265317339386
cardiac2041118301074185114165185228271
rhythm2342118301072779120153204281
during26531183010750100129150200253
cardiac425132301073980107154173213253
arrest69513230107406693136169198
and910132301074087136
might1063132301077391140187214
result1294132301072668102148167195
in1506132301071866
better1589132301074893120151193219
neurological1825132301074791138165211231278328346386427446
one-year2288132301074795139168207250290316
survival,2621132301073380106149169209250269284
higher425146301074868118167212239
rates68614630107266997140175
of883146301074873
sustained978146301073381115145187207255300351
ROSC13511463010746107149202
and1575146301074089140
long-term1737146301071968117168196225269296371
survival2130146301073482109154174216259278
compared2430146301074088163213256283327378
to2830146301072875
patients425160301075092120140185234261297
without785160301076585114163213262291
any1098160301074190130
breathing1250160301075078122163191240259308358
activity1631160301074182114133175196225268
[1–3].192216010109267011315918321041603010716
Gasping2142160301075699133183203252302
is2467160301071952
supposed2542160301073381132183233267312363
to425174301072875
be526174301074995
easily647174301074384119138157198
recognisable871174301072670112160211260279313356406427472
sign1368174301073453103152
of1545174301074873
cardiac1643174301074083110159179220261
arrest193017430107416896140175204
by2160174301075090
typical2275174301072872123143184227247
breathing2547174301075078121163191240259308358
pattern425188301075093121153196224274
with728188301076585114164
very920188301074186113157
short1106188301073483132160192
inspiration1327188301071968102152173200243271291341390
and1746188301074190141
long1915188301071969119169
expiration2113188301074484136156183226255275324374
pause2515188301075093142176221
and2764188301074291141
dispatchers425202301074968101151193221260308353380415
are858202301074067111
trained98720230107275597116164209259
to1265202301072774
recognize1357202301072770112159209258277314358
cardiac1733202301073981108157176217258
arrest200920230107416895139173203
in2230202301071867
spite2315202301073383103131174
of2507202301074872
gasping.2598202301074889123173193241291307
However,4252163010757107173217259304331344
as797216301074176
stated901216301073464106135178230
in1159216301071968
the1255216301072877123
ERC1406216301074288141
Guidelines15752163010757106126176221242261310356390
2021,1994216301074488131171183
gasping2205216301074991125176196245296
may25292163010774116156
be2713216301075096
in2838216301071867
fact425230301072366107138
often582230301074772104147196
misinterpreted796230301077393126145193221264291342370413442485535
as1349230301074175
normal1442230301074897125200241261
breathing,1721230301074977121161189238257305355372
i.e.21112303010719358095
a22252303010740
sign2284230301073352102150
of2452230301074873
life,254323030107193863107122
which26832303010765114133174223
poses4252443010750100134179214
a6672443010740
problem735244301075078126177197242317
for1079244301072472100
both12072443010750100128177
lay1412244301071960100
people1539244301075096146197217262
and1829244301074190140
healthcare1997244301074893134154183232273316343387
professionals.2412244301074977125150194229263282331381422442476493
Gasping,425258301075698133183203252302318
especially763258301074478128174216236277297316357
if1140258301071843
it1203258301071948
has1270258301074890124
a14142583010741
high1474258301074868118167
frequency166025830107245296147196241290331374
and2054258301074190140
relatively221325830107277191132160180222266286327
high2560258301074868118166
tidal274625830107284898139159
volumes,425272301074189110158232277312329
may7812723010774115155
remain963272301072771145187206255
a12452723010741
barrier1313272301075092120148168213240
to1580272301072876
recognise1683272301072670112160211260279313358
out-of-hospital2068272301074897126151202227254304353388438458487529549
cardiac2644272301074083110159179220261
arrest42528630107406794137171200
(OHCA).We643286301072482139191245269282353395
describe1055286301074993127167194214263308
such1381286301073380121169
an1567286301074089
untypical1673286301074795122165216235275317336
cause2027286301074081129162206
of2250286301074872
respiration2340286301072669103152171198240267286334383
after274028630107416496139165
cardiac425300301074184112162182223266
arrest,72030030107416997142177208225
which9743003010766116136178228
was12313003010765109143
further1403300301072475103135185231259
confirmed1691300301074089139164185213289335387
by2107300301075091
ECG2227300301074295150
as2406300301074176
ventricular2511300301074186136164192213255304325367395
fibrillation.42531430107244495122143162182223251271320369386
Case4253387015377141195256
Report7043387015381143213279339394
After425356301075376108151177
emergency6283563010744118162189237281330370413
call1067356301074082101120
from121335630107235198173
a14123563010741
layman,147935630107196099174215263278
an1784356301074189
Emergency18993563010742115160186235279327368410
Medical23363563010770114164183223265284
System2646356301074280114143185259
(EMS)425370301072465134175198
dispatcher63937030107496799148189216254301345371
evaluated1026370301074383123141187226252293342
situation138237030107335077123163188206252300
as1696370301074072
a17833703010740
cardiac1837370301074080105152169208247
arrest209937030107406591133165193
with2306370301076482109156
gasping2476370301074988120167185232280
and2770370301074087135
telephone-assisted42538430107276886128176223270317359386425457489506537564605653
cardiopulmonary1092384301074080105151168214263309327398444491530555596
resuscitation1702384301072768100145177215233259299324342388435
(TA-CPR)2151384301072367112137190233275297
was24623843010764104136
initiated.261238430107186482108125164190230279293
The425398301074292135
patient’s585398301075092118136180228254273303
son,913398301073482130145
a10833983010741
30-year-old1149398301074487117156199239265289339358407
man,15813983010774114162177
performed1783398301075094120147194220294338388
chest2196398301074088132165194
compressions2414398301074187161210237279312345363411459491
without425412301076786115164213262291
artificial742412301074268100119143163204222263283
ventilation.1050412301074286135162181200242269288337386403
EMS14794123010743114157
team1662412301072871112187
with1875412301076786115164
the2065412301072978123
physician22144123010751100140174192233252293342
arrived258241230107426996116157201252
628604123010745
minutes425426301077491138185212254287
after73342630107416394136161
the915426301072875119
emergency10554263010744116160185232276323363404
call.148042630107408199117131
The1633426301074190134
patient,1788426301074990116134177224250266
a20754263010741
56-year-old2137426301074486115154196236261285334353401
male,25594263010774114132175188
had2769426301074888136
on425440301074895
arrival53544030107416693111151191209
of759440301074871
EMS8454403010742111151
team1011440301072869109181
diagnosed1207440301074966106154201248281324373
cardiac1595440301074080106153171210249
arrest185944030107416693134167195
(OHCA)2069440301072481138188241264
and2348440301074188136
the2499440301072875118
primary263244030107497594166206231273
ECG425454301074293146
revealed596454301072669109152192210254304
VF.92445430107478996
The1044454301074392136
patient1205454301075091118136179227254
was14844543010765106139
gasping,1648454301074990122171190237286302
having1974454301074989129148195244
deep2243454301075093138187
breaths2455454301075076119159185233266
with2746454301076584111159
significantly42546830107345199146164187206245286333359377416
longer859468301071966114162205231
post-expiratory1107468301075098131159183228267316334359400426472498540
pauses1665468301074990137169212245
at1927468301074167
a20124683010741
high2070468301074866114161
rate224946830107266793135
of2401468301074871
24/min.2490468301074483113184202249264
The2771468301074291134
EMS4254823010743114155
team606482301072871111186
took817482301072875125163
over1006482301074989133159
chest1190482301074190134168197
compressions,1412482301074188163213240283317350368416465498514
and1952482301074190139
immediately2117482301071993167212262281321348391410450
after259348230107416596139166
the2784482301072877121
cardiac425496301074079104151168207246
rhythm685496301072673110139186257
was9564963010765104136
evaluated,1106496301074382122140185224250291339353
a14734963010741
defibrillation1528496301074890113131179204222239256295321338384431
shock1973496301073480126166202
(2002189496301072465106150
J)2353496301073153
was24204963010764104136
delivered,2570496301074891109126165206231273321335
resulting425510301072668100146163190208254302
in741510301071965
ROSC8215103010745104144194
(Figures102951030107246381128174199241273
113175103010743
and1375510301074087135
2).152451030107446576
The1615510301074190132
patient1762510301074989115133175222247
continued2024510301073985132157175221267310358
with2397510301076482109156
abnormal2567510301074189136183209281321338
breathing425524301075076118157183231248295344
pattern784524301074990116146188213261
on1060524301074896
a11715243010741
Venti1227524301074586133159177
face-1419524301072465104146174
mask16085243010774114146183
with1806524301076583110158
oxygen1979524301074885127174217265
supply2259524301073379128177196235
825095243010744
l/min2568524301071950121139186
and2769524301074188136
SpO2425538301074188147568544806325
100%.608538301074381124189205
A8275383010751
peripheral892538301074992117134181228270295334352
venous1257538301074082128174220251
catheter1522538301073979104150192218259283
was18195383010764103135
inserted196753830107196596138163192232280
in2261538301071864
his233953830107476495
right244853830107264390136161
forearm,262353830107236894134173197269283
and425552301074086134
amiodarone5735523010740111128174223261286331378420
3001007552301074385129
mg11505523010773120
was12845523010764104135
administered.1433552301074088159176222239270297338363404452466
The1929552301074189131
patient2074552301074989114131173219245
had2332552301074887134
non-specific2480552301074894141167199247290329346369387425
response42556630107266799146193240271313
to752566301072872
pain838566301074989106152
stimulation100456630107336077148194211250275292338385
(Glasgow140356630107237593132163211257320
Coma1737566301075095167205
Score1956566301074180125150191
7)2161566301074366
and2241566301074086133
within2388566301076482108154171217
the2619566301072874116
next2749566301074790127156
24255803010743
minutes482580301077289134179205246277
after77358030107406291131156
ROSC,9425803010745103142191205
ventricular1160580301074081127152177194232278295333357
fibrillation153158030107234188113130147164202228245290337
returned.188158030107266793138163209251299313
Second2207580301074183122167213260
defibrillation2480580301074890112130177202219236253291317334379425
shock425594301073481128169206
(200655594301072466108153
J)832594301073154
was9115943010765105138
performed,1073594301075094120146193219292336385400
but1497594301075097125
did1646594301074967115
not1786594301074895122
result1932594301072769102148166193
in2150594301071866
ROSC22405943010745105146196
(Fig.246159430107246481130145
3).263059430107446477
After2731594301075375106148173
next425608301074892130160
26056083010744
minutes,669608301077391138185212253286301
with990608301076583111158
continuing1168608301074086133159177224271288335384
chest1572608301074087130163191
compressions1783608301074086159208234276308341358405453485
and2288608301074188137
gasping2444608301074989121170188235284
with2747608301076584111158
the425622301072875118
same567622301073475148191
pattern782622301075090117146188213261
as1067622301074174
in1165622301071966
the1255622301072775118
beginning,1397622301075094143161208255272319368383
a18046223010740
third186962230107277592118165
defibrillation2058622301074992115134182208227245262302328346393441
shock2523622301073480128168205
(2002752622301072466108153
J)425636301073255
was5066363010766107141
delivered,672636301075094113131172216242285336351
leading1048636301072064104154172220270
to1344636301072875
definitive1444636301075094118137186204232250292335
ROSC18046363010747108149201
(Fig.203063630107256684133149
4).220463630107456679
Another23096363010753102150178226271297
dose2631636301075099132177
of2833636301074973
amiodarone4256503010741112130176225264289334382424
150864650301074379121
mg9996503010773121
in1134650301071965
a12146503010740
continuous1269650301073984132157175221267314360392
infusion167565030107196587135166183230277
was19666503010764104136
administered.2117650301074088160177224241272300341366407456471
The2602650301074190132
total274965030107277298138156
time425664301072845117160
interval60066430107186591132157200240258
from87266430107245096169
OHCA10556643010760116166219
to1289664301072773
ROSC13766643010745105145195
was15856643010765105137
121736664301074480
minutes.1831664301077390137183210251284299
After2145664301075275105146171
successful2331664301073379118156197229261285333350
ROSC,26966643010745104144194209
the425678301072876120
patient570678301075092118137180228255
had850678301074889138
the1013678301072876120
following115867830107247191109157221240288337
circulatory152067830107415985123171189230256303329372
parameters:1917678301075092118159233277304346372406421
blood2363678301075069117166216
pressure2604678301075077119153186233259301
102/83425692301074483123156198240
mmHg,6856923010773146202250265
pulse970692301075097115147190
124/min,1180692301074481120150221238285300
SpO215006923010742901511647698806326
remained1693692301072769141181199246289338
100%2051692301074483128194
with2265692301076583111158
spontaneous2443692301073482130178204244291335383430462
ventilation425706301074182129155173190230256274320368
using80770630107488097144192
a10137063010741
Venti-mask1069706301074585132158176202275315347384
with1467706301076583110157
oxygen1639706301074784126173216263
flow191770630107234491155
820867063010744
l/min.2145706301071950120137184199
The2359706301074190133
patient2507706301074989115133176223248
had2770706301074888136
still4257203010733617997114
breathing554720301075075117156182229247294342
pattern911720301074990116145187212260
inspiration118572030107196698146164189230256274320368
to1568720301072773
expiration1656720301074382131149174215241258305353
120237203010744
:20827203010716
321127203010744
and2171720301074187136
gasping-like2321720301074989121169187234282309328346382424
face2760720301072364104145
and425734301074087134
chest573734301074086129161188
movement,7757343010773120158200271314360385400
but1189734301074996122
gained1325734301074988105151193241
consciousness1581734301073984131162201218264311342388430463494
and2089734301074187134
started2238734301073360100125154195243
to2495734301072772
complain2581734301074085157204223261279325
on425748301074896
dyspnoea536748301074988121169217265309348
and899748301074188137
chest1051748301074087130163191
pain.1257748301075091108155171
During14437483010758106131149196245
resuscitation1703748301072769101148180219237264305331349396444
we21627483010765107
repeatedly2284748301072769118162201227269318336375
solved2674748301073481100140182232
the425762301072877122
dilemma57376230107506988132207282323
whether9227623010767116161189238283309
to1257762301072976
transfer135976230107285597146179204248275
the1660762301072877122
patient1808762301075193120139184232259
to2093762301072976
artificial219576230107426899118142162203222262281
pulmonary25027623010751100119194243292333360403
ventilation425776301074183130156174192232258276323371
or818776301074874
to914776301072873
keep1009776301073981125173
him1204776301074966139
on1365776301074895
gasping.1483776301074988121169187234283298
We18037763010774115
did1940776301074967115
not2077776301074896122
find222177630107244390138
factors2381776301072465105134180206239
leading2643776301071962101149167214263
to304762301072874
a3142623010741
clear-cut320462301074058101140166189231278305
solution,353062301073481100147174192239287301
and385362301074088136
the401062301072875119
advantages415062301074189130170217243284332375408
and457962301074188137
disadvantages47376230107496799140188228269316342383431474507
of526562301074871
each535862301074382122169
solution30477630107338199146173190237285
are334776301074066107
given346976301074967107149196
in367976301071966
the376076301072774117
discussion38927630107496798138184216248266313360
below.426776301074993111158222234
In451676301071966
the459676301072875118
end,472976301074390139153
the489776301072875118
opinion502976301074897115162180226274
not531876301074895121
to545476301072873
start304790301073360100124154
artificial32149030107416594112134152190207246263
pulmonary349190301074995112183230276315340381
ventilation388690301074081127152169186225250268314360
prevailed,426090301074974115154193210228270318332
although46059030107415884130177223270316
it493590301071845
was4994903010764103135
not514290301074894120
an527690301074086
easy537690301074381112151
decision.3047104301074991131148180197243290305
He33661043010757100
was34801043010764104136
administered3630104301074189161178225242273301342367409457
fentanyl4101104301072466113138178224262280
0.1439510430107445895
mg45051043010773121
i.4640104301071933
v.4687104301074151
in4753104301071865
two4832104301072894140
increments4986104301071965104129171243286332358391
and5392104301074087135
a30471183010741
normal3108118301074896122195235253
breathing3381118301075076118157183231248295344
pattern3745118301075090117146188213261
returned402611830107276996143168216260309
gradually4355118301074974115164210250268286325
in4700118301071966
approximately4786118301074189138164211248266339378405446465504
553101183010744
min.5374118301077391138153
Before3047132301074589112158185227
transfer329313230107285495142174198240266
to3578132301072874
a36721323010740
hospital,3732132301074896128177195222263281295
a40461323010741
12-lead4107132301074480105124167206255
ECG4381132301074292144
was45451323010765105138
recorded4702132301072769109155181228271321
(Figure504213230107246482130176202244
5)5305132301074466
and5391132301074188136
acute3047146301074181127155196
anterior3267146301074188114156181200247273
myocardial35641463010774111158198239264312329369387
infarction397514630107196588129155193222240287335
(AMI)4334146301072475145163186
was45441463010765105137
diagnosed.4705146301074967106155202250282326375390
The5119146301074291134
patient5277146301074990116134177224250
was30471603010765105137
referred319816030107266890132158184225274
to3486160301072873
a35741603010740
coronary3629160301073985110156203243268309
ICU3953160301071969123
for409016030107247096
coronary4200160301074085111156204243268310
intervention452416030107196591132157200242288314332378425
(PCI).4964160301072367117134156168
Laboratory5147160301074081129177202242268313339381
tests3047174301072869102130164
on3230174301074896
admission3344174301074190162180212244261309356
confirmed3719174301074086134156175200274317366
adequate4104174301074189132181228268294336
oxygenation4458174301074886127175218265305331349397444
(arterial492117430107246187117158184202242260
pO2519917430107501115306180806326
19.07535117430107448193137177
kPa),3047188301073884123144157
alkalemia322418830107415996137156199271289328
(pH3573188301072473130
7.564)372418830107444993136181201
with3946188301076584111158
hypocapnia4125188301074886136184224265313361379418
(pCO24564188301072473125181221
2.494806188301074458101142
kPa)4969188301073883123144
and5134188301074088136
lactate529118830107195998128168194236
5.73047202301074458101
mmol/l.31732023010775148197216248267283
Subsequent3481202301074289138171215265312356404431
selective393720230107347896140181211229270313
coronary4275202301074187113160209249275318
angiography4618202301074189138156204254280321371419458
revealed5101202301072669109152192211254304
no5430202301074997
significant304721630107345199146164187206245286333359
lesion342121630107196295112160207
of3644216301074771
the3730216301072875118
coronary3864216301074085111158205245271313
arteries.419221630107416696138164182225258274
The4481216301074291134
patient4630216301075091117135178225251
had4896216301074888137
after504821630107416394136161
previous5224216301075076118158177224271303
aortic3047230301074188114144162201
valve326323030107408199138181
replacement,3458230301072769117136175215256329372419445460
currently3933230301074087112138180227253271310
with4258230301076483110157
significant443023030107335098145163186205244284331357
regurgitation.4802230301072668117164189236254281321347365412459475
His5291230301075774106
left541223030107196285115
ventricular3047244301074082129154180198237283301340365
ejection3426244301074461103143172190236284
fraction372424430107235090129158176222269
(LVEF)4008244301072362101143182206
was42282443010765105137
55%.4379244301074483146162
The4555244301074290133
patient4702244301074990115133175222248
was49642443010764104136
implanted5115244301071890138157196242268309357
a54872443010740
cardioverter3047258301074081106153171218258300326356397423
(BiV348625830107246886132
ICD)3635258301071969126147
and3798258301074188137
was39512583010765106138
discharged410525830107496799139186225251298341391
after451225830107416394136161
446892583010744
days4750258301074988126159
of4926258301074771
hospitalization5013258301074896128177195222262281298334375401419466514
without3047272301076583110158205253280
any3344272301074188126
neurological3487272301074992139164210229276326343383423441
deficit.3946272301074992115134173191218233
In4197272301071966
spite4280272301073482101128169
of4467272301074871
verbal4555272301074183109158199217
contact4789272301074086134160200240269
during5076272301074995121139186235
transport,5328272301072854941421743047286301075098124154169
he3233286301074992
had3342286301074888136
complete3495286301074086159208227270297338
amnesia38502863010741114161204237254294
for416128630107237096
the4274286301072875118
entire4409286301074491117135160202
duration4628286301074996121162188206253301
of4946286301074871
all503428630107415976
procedures5127286301075076122163204253300325367400
including3047300301071966105123170218236283332
the3396300301072876119
first353330030107234268101129
236803003010744
hours3742300301074896143168202
of3963300301074771
hospitalization.4054300301074897130180199227268287306342384411430478527543
Discussion30477447015382123178237310363418459524597
We30477623010774116
present3190762301075077120154199248275
a34917623010741
very3559762301074184111154
abnormal3740762301074191140189216291332351
agonal4118762301074191139188230249
breathing4393762301075077121161189237256304354
during4774762301074997123143191241
cardiac5041762301074182109158177217258
arrest532676230107416795138172201
and3047776301074188137
post-resuscitation3201776301074998131160184211254287334366406425453494520539587635
period.3852776301075094120139187237252
This4121776301074191109141
case4279776301074081114157
opens4453776301074797142189222
questions4691776301074996140173202220268316349
when50567763010765113157205
to5277776301072874
start5367776301073362103129160