How dispatchers recognize agonal and abnormal breathing in suspected cardiac arrest: A scoping review

Early recognition of out-of-hospital cardiac arrest is frequently hindered by agonal or abnormal breathing, leading to delayed dispatcher-assisted cardiopulmonary resuscitation. Improving recognition of respiratory anomalies can optimize early intervention and survival. This scoping review aimed to map strategies used by emergency medical dispatchers to identify respiratory anomalies predictive of cardiac arrest during emergency calls.

A scoping review of the literature was performed following Joanna Briggs Institute recommendations and reported according to the PRISMA-ScR guidelines. The population, concept, and context (PCC) framework focused on (P) dispatchers and the (C) strategies to recognize breathing abnormalities predictive of cardiac arrest, (C) during emergency calls. Experimental, observational, and qualitative studies from PubMed, Scopus, Cochrane Library, and CINAHL up to June 30, 2025, were included.

From 109 records, 16 studies met the inclusion criteria. Three thematic areas were identified: modifications to dispatch protocols, adding focused questions to improve detection of agonal breathing and cardiac arrest; hand-on-belly assessment, although rarely used, enhanced diagnostic accuracy but introduced modest delays in cardiopulmonary resuscitation initiation; and caller-reported breathing descriptors reduced missed or delayed recognition of cardiac arrest. The importance of dispatcher training, caller-related factors, and the use of technological aids were identified as secondary cross cutting themes.

Strategies such as protocol adjustments, hand-on-belly assessment, and systematic use of breathing descriptors may strengthen dispatcher recognition of cardiac arrest. Structured training on technical and communication skills is essential to optimize their application. Further research should evaluate the impact of these interventions on survival outcomes across diverse cultural and organizational contexts.