A 16 year old girl swimmer died after a lifeguard stopped CPR when she started breathing again. She thought that she had saved her life a Coroner heard…
Abstracts:
Heart specialist Dr Christopher Duke said Sophie ‘would have survived’ if she had received continuous CPR. He said ‘You don’t stop resuscitation just because a patient appears to be breathing. You only stop if there’s breathing and a pulse.’
The coroner Catherine Mason said she would write to the Resuscitation Council of the UK, which provides guidelines for life-saving techniques, to ask it to amend its training guidelines to include checking for a pulse.
The inquest herad Sophie’s initial cardiac arrest was caused by an undiagnosed herat condition.
Comment:
The Casualty could have easily re-arrested causing death. Detecting a pulse (or the absence of one) would have identified the need to continue CPR. However, it is likely the first aider misinterpreted ‘Agonal’ breathing (which is a sign of dying) with ‘Normal’ breathing (a sign of life). If this is the case, ineffective training may be the problem not the first aider or the Resuscitation Council’s guidelines.
A first aider is not a medical professional and in this the case the first aider has acted in good faith and within her training. Overall, the first aider deserves praise for her actions, not critics.
(Note: AoFA comments are take their basis on reported news items as stated below.)
UK Resuscitation Council Guidelines:
Studies have shown that pulse checking is difficult and unreliable especially for laypersons including first aiders. Indeed some years ago, basic life support (BLS) training removed from its guidelines pulse check and checking for ‘Signs of Life’ and replaced it with a single ‘Normal Breathing’ check. This change was designed to simplify and improve the outcome of CPR.
Agonal Breathing:
Agonal breathing is present up to 40% of pre-hospital cardiac arrests. It is important that first aiders can recognise agonal breathing.
Agonal breathing can sound like gasping, snorting, gurgling, moaning or laboured breathing. It is NOT ‘normal’ breathing.
If in doubt, do CPR. It is better to do CPR when not needed that not to do CPR when needed!
First Aid Training:
Make sure your training emphasises the difference between normal and agonal breathing.
First Aid for Life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken based on this information. We strongly recommend that you attend a first aid course to understand what to do in a medical emergency.
I had a bizarre experience tonight. A man collapsed on the top deck of a double decker bus. “Is there a doctor on the bus?” So I responded. Though retired from general practice 15 years I have had first aid training regularly and the last 4 years ago. I have had many experiences of active CPR and dashes to hospital with the ambulance whilst working. I/we+paramedics have delivered at least two of these patients to hospital alive. Today the man in question had agonal breathing with typical frothy phlegm and bloating tongue. The bizarre point was that I was actively interfered with by the other bystanders (who were not medics). They insisted that I should stop cpr and were physically interfering with my attempts. The assertion that “I am a doctor, this man needs CPR” had no influence. They were adamant that the man was breathing (agonal breathing and pulseless) and that I was doing much harm. They ganged up on me to the point that I had no alternative but to stop trying. I did not rate his chances anyway (probably less than 10%). However, this is a real lesson in the need to manage such a situation. Any thoughts?
Follow up, he was declared dead by the paramedics when they turned up. He could have been sufficiently “alive” to defibrillate if the cpr had been allowed to continue.
I’m so sorry about your experience Jamie and know exactly how you felt at the time. I had a similar experience several years ago whilst on holiday, thankfully with a positive outcome. I’m a healthcare professional (not a doctor) but recognised that the collapsed gentlemen had agonal breathing after receiving bystander CPR which was immediately stopped. I had to practically fight off those present to continue CPR when he appeared to be breathing “normally”
We were close to the local hospital so the ambulance arrived in good time, which I was thankful for as I’m sure I would have had a riot on my hands. The medics praised me for the fact that I’d continued CPR even though bystanders wasted no time in reporting that I should have ceased when he started breathing. I later checked in the ER on his condition and was informed that my actions may have saved his life
I’m sorry that the outcome wasn’t as positive as yours Jamie and agree that more education is needed in this area when it comes to bystander CPR
I’m so sorry about your experience Jamie and know exactly how you felt at the time. I had a similar experience several years ago whilst on holiday, thankfully with a positive outcome. I’m a healthcare professional (not a doctor) but recognised that the collapsed gentlemen had agonal breathing after receiving bystander CPR which was immediately stopped. I had to practically fight off those present to continue CPR when he appeared to be breathing “normally”
We were close to the local hospital so the ambulance arrived in good time, which I was thankful for as I’m sure I would have had a riot on my hands. The medics praised me for the fact that I’d continued CPR even though bystanders wasted no time in reporting that I should have ceased when he started breathing. I later checked in the ER on his condition and was informed that my actions may have saved his life
I’m sorry that your outcome wasn’t as positive as mine Jamie and agree that more education is needed in this area when it comes to bystander CPR
So sorry to hear he didn’t make it and the awful time you had trying to resuscitate him too. I have never experienced anything like that and it must have made a distressing situation even worse for you. Sending you my best regards and thank you for sharing this.
Dear Anna Marie and Jamie, congratulations to both of you for sticking to your guns, recognising agonal gasps and doing CPR. You both gave your casualties the very best chance. Best wishes Emma
I found this page when searching the web after a very traumatic experience on Saturday. A friend of mine sadly passed away after a cardiac arrest at a gym. He was feeling unwell and started having problems breathing. We sat him on the floor and he had what looked like a fit, which is when I shouted for the ambulance to be called. A first aider came over and checked his pulse and he seemed to be breathing. No cpr was given. Another person was on the phone to the ambulance control room and was telling the operator every time he heard a breath. The breath was like a snoring sound, which I now recognise as agonal breathing, the ambulance arrived in 7 minutes and the paranedic started cpr but unfortunately after a prolonged fight to recusitate, there was no more that could be done. He was pronounced dead when he arrived at hospital. I heard the paramedic tell the first aider that he had mistaken agonal breathing for normal breathing and cpr should have been given. I feel really guilty that a) I didnt recognise he was in trouble early enough (we were training together) and b) as a reasonably intelligent and inquisitive person who has done some basic first aid training a few years ago, I didn’t know about agonal breathing, I’m also surprised that the 999 operator didn’t pick up on it, it’s a really painfull thought that he might have been saved if we had been quicker to begin cpr. I wonder what can be done to educate more people about this. Now that I’ve done some research this was almost a text book example of how the cardiac arrest was missed as it looked like he had a fit and then had laboured breathing. I can’t undo what happened but I feel I should do something to help make sure this kind of mistake happens less often.
I am so desperately sorry this happened to you. In a panicky situation t is so easy to mistake agonal gasps for breathing, which is why I am trying to raise awareness of this.
You have been through a very traumatic experience, please look after yourself too. If there is any additional support I can give, please don’t hesitate to contact me.
You have prompted me to create further information about this critical issue today, thank you.
I am writing this on behalf of a friend who is taking care of his 89 years old mother.
What are the visible symptoms through which we can distinguish between agonal breathing in dying people and gasping in people who are not near death but still have breathing problem?
Thanks and best regards.
Thank you for your message. Agonal gasps occur when someone is unresponsive and breathing in a very strange way, this video may help: https://www.youtube.com/watch?v=pCJrgcC3sgI