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 the presence of agonal or abnormal breathing, which can lead to delays in dispatcher-assisted cardiopulmonary resuscitation. Improving the recognition of respiratory anomalies may optimize early intervention and improve survival outcomes. This scoping review aimed to map the strategies used by emergency medical dispatchers to identify respiratory anomalies predictive of cardiac arrest during emergency calls.

A scoping review of the literature was conducted in accordance with JBI recommendations and reported following the PRISMA-ScR guidelines. The PCC (population, concept, and context) framework focused on emergency medical dispatchers, strategies to recognize breathing abnormalities predictive of cardiac arrest, and their application during emergency calls. Experimental, observational, and qualitative studies indexed in PubMed, Scopus, the Cochrane Library, and CINAHL up to June 30, 2025, were included.

Of 109 records identified, 16 studies met the inclusion criteria. Three thematic areas emerged: (1) modifications to dispatch protocols, including the addition of focused questions to improve detection of agonal breathing and cardiac arrest; (2) hand-on-belly assessment, which, although infrequently used, improved diagnostic accuracy but introduced modest delays in cardiopulmonary resuscitation initiation; and (3) the use of caller-reported breathing descriptors, which reduced missed or delayed recognition of cardiac arrest. Dispatcher training, caller-related factors, and the use of technological aids were identified as secondary cross-cutting themes.

Strategies such as protocol modifications, hand-on-belly assessment, and the systematic use of breathing descriptors may enhance dispatcher recognition of cardiac arrest. Structured training that integrates technical competencies and communication skills is essential to optimize the implementation of these strategies. Further research should evaluate the effects of these interventions on survival outcomes across diverse cultural and organizational settings.