Cases of prolonged cardiac arrest with preserved gasping successfully resuscitated with ECPR

Longer cardiopulmonary resuscitation (CPR) time is associated with worsened neurological outcomes in out-of-hospital cardiac arrest (OHCA). Gasping during CPR is a favorable neurological predictor for OHCA. Recently, the efficacy of extracorporeal cardiopulmonary resuscitation (ECPR) in refractory cardiac arrest has been reported. However, the significance of gasping in refractory cardiac arrest patients with long CPR durations treated with ECPR is still unclear. We report two cases of cardiac arrest with gasping that were successfully resuscitated by ECPR, despite extremely long low-flow times. In case 1, a 58-year-old man presented with cardiac arrest and ventricular fibrillation (VF). Gasping was observed when the patient arrived at the hospital. ECPR was initiated 82 min after cardiac arrest. The patient was diagnosed with hypertrophic cardiomyopathy. ECMO was withdrawn on day 4, and the patient was discharged without neurological impairment. In case 2, a 49-year-old man experienced cardiac arrest with VF, and his gasping was preserved during transportation. On arrival, VF persisted, and gasping was observed; therefore, ECMO was initiated 93 min after cardiac arrest. He was diagnosed with acute myocardial infarction. ECMO was withdrawn on day 4 and he was discharged from the hospital without any neurological impairment. Resuscitation and ECPR should not be abandoned in case of preserved gasping, even when the low-flow time is extremely long.