Agonal Breathing & Availability of AEDs
By Harry Keown
Agonal breathing was highlighted at the recent ERC conference and it has been part of BLS training since the guidelines changed in 2005 but many trainers do not emphasise the importance of it and many students do not understand what normal breathing is. It is up to us as trainers to emphasise it.
The BLS guidelines state, “Agonal gasps are present in up to 40% of cardiac arrest victims. Laypeople should, therefore, be taught to begin CPR if the victim is unconscious (unresponsive) and not breathing normally. It should be emphasised during training that agonal gasps occur commonly in the first few minutes after a cardiac arrest. They are an indication for starting CPR immediately and should not be confused with normal breathing.”
In November 2007 an article appeared in the British medical Journal sparking such debate and the following is an extract from it, “Every year about a quarter of a million people in the UK have a heart attack. Just over half of them live through it. Most people who don’t survive die before they reach hospital. Getting to hospital quickly makes it much more likely that you’ll survive. If you reach hospital, you have a 90% chance of living for at least a year.”
I was further prompted to write this article following a BBC news report on 25th February 2010;
The life of a talented teenage swimmer could have been saved if first aid at the pool where she died had been continued, a Coroner has found.
Sophie Konderak, 16, got into difficulty while training with Leicester’s elite performance team in September.
An inquest heard she died from an undiagnosed heart condition. The Coroner said she could have survived if a defibrillator had been used. Sophie had been described as a ‘water baby’ who had ambitions to compete with the Olympic team as well as becoming a doctor.
The inquest heard that a pool lifeguard was following training guidelines when she stopped carrying out chest compressions after Sophie started breathing again; but experts say they were in fact her dying breaths.
The Coroner said, “When Sophie became acutely unwell there was a window of opportunity to treat her. Basic life support was given but not continued, in accordance with training. Had it been continued and a defibrillator applied, on the balance of probability, she would have survived.”
AEDs have been around since the 1960s and there is an opportunity for us to expand the provision and training in the use of AEDs and at the same time improve the standard of pre hospital care for the public. AEDs are simple and safe to use and are most effective when used as short a time after arrest and when CPR is being performed. Remember CPR is only one link in the ‘Chain of Survival’ defibrillation is the next link. For some time now I have encouraged corporate clients to provide AEDs as part of their extended care for employees, visitors and contractors.
In November 2009 the UK Resuscitation Council issued the following statement which I found to be refreshing; “AEDs have been used frequently by laypeople with modest training, and many reports testify to the success of this strategy. Operators without formal training have also used AEDs to successfully save lives.
While it is highly desirable that those who may be called upon to use an AED should be trained in their use, and keep their skills up to date, circumstances can dictate that no trained operator (or trained operator whose certificate of training certificate has expired) is present at the site of an emergency. Under these circumstances no inhibitions should be placed on any person willing to use an AED.”
I believe that we as trainers can improve survival rates by ensuring that the training we provide and advice we offer is part of a nationwide survival strategy. Firstly we have to improve the quality of CPR training and secondly we have to increase the availability of AED’ for public use and our members could play a vital role in this. I am certainly all for it if it saves lives.
These are my personal thoughts and do not reflect the opinion of the First Aid Council for Training though I would be interested in knowing how many of you felt the same way. Any positive feedback would be welcome.
Harry Keown – CHIPFAST Ltd.