What is Agonal Breathing: Know the Causes and Proper Treatment

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Key Takeaway

  • Agonal breathing is an abnormal and often labored pattern of breathing that can occur during the early stages of sudden cardiac arrest.
  • With the help of CPR, individuals exhibiting agonal breathing have a higher chance of surviving cardiac arrest than those who do not.
  • Agonal respiration is characterized by labored noisy breathing with long pauses and gasps.
  • Possible causes of gasping respiration included cardiac arrest, stroke, drowning, suffocation, choking, and opioid overdose.
  • In the event of a gasping respiration and unresponsiveness, it is essential to contact emergency services as the first step.
  • You can respond to cases of agonal breaths by providing CPR chest compressions and using an AED.
  • Other medical intervention include administering drugs to treat the underlying cause and provide ventilation or intubation if oxygen isn't entering the body properly.


In the event of sudden cardiac arrest, victims may exhibit heavy breathing for a few seconds to a few minutes after their heart has stopped. It is important to note that this type of breathing is not normal and requires urgent action. Continue reading to discover what action to take in response to this agonal breathing.

definition of agonal breathing

What is Agonal Breathing?

Agonal breathing is an abnormal and often labored breathing pattern that can occur during the early stages of cardiac arrest. Slow, shallow breaths characterize it with pauses in between and is often accompanied by gurgling or snoring sounds. Agonal breathing is not true breathing, and It indicates a person is in cardiac arrest, and medical attention should be sought immediately.

Agonal respiration occurs when oxygen levels are dangerously low. Commonly associated with cardiac arrest or stroke, it is not a voluntary act of breathing but rather a reflexive response from the brain in an attempt to survive. Agonal breathing is often seen as an indicator that a person is nearing death, yet it can also signify that the brain is still functioning. With the help of cardiopulmonary resuscitation (CPR), individuals exhibiting agonal breathing have a higher chance of surviving cardiac arrest than those who do not.


What is the medical significance of agonal breathing?

The medical significance of agonal breathing is that it is often a symptom of a life-threatening medical emergency such as cardiac arrest or respiratory failure. Agonal breathing can be a sign that the body is not receiving enough oxygen and is in need of immediate medical attention. Therefore, it is important to recognize the signs and symptoms associated with agonal breathing so that appropriate steps can be taken to provide the necessary medical treatment.

How does agonal breathing relate to cardiac arrest?

Agonal breathing is often associated with cardiac arrest, which occurs when the heart’s electrical system malfunctions and the heart stops beating. When this happens, agonal breathing can occur due to oxygen deprivation in the body. Agonal breathing is one of the first signs that a person is experiencing cardiac arrest, and it typically appears within seconds to minutes after the onset of cardiac arrest. Therefore, recognizing the signs and symptoms of agonal breathing can be vital to providing timely medical treatment.


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What are the signs and symptoms of agonal breathing?

The signs and symptoms of agonal breathing can vary depending on the underlying cause. However, common signs and symptoms include shallow, rapid breaths that are often labored or spasmodic, with pauses between breaths.

A person experiencing agonal respiration typically breathes slowly, averaging around 10-12 breaths per minute, in contrast to the 12-25 breaths per minute typical of a person not experiencing respiratory distress. The disparity will likely be noticeable unless the person is a slow, controlled breather like one who practices yoga. Additionally, involuntary muscle spasms may be observed, which could be mistaken for a heartbeat. This is probably a reflexive response.


Other possible signs and symptoms may include:

  • Intense headache
  • A weak pulse
  • Facial drooping
  • Blue discoloration of the skin (cyanosis)
  • Confusion or disorientation
  • Slurred speech
  • Chest pain
  • Sweating
  • One side of the body becomes limp
  • Difficulty comprehending spoken language


How can agonal breathing be distinguished from other types of breathing?

Agonal breathing can be distinguished from other types of breathing by its irregular and labored pattern. Agonal breathing is characterized by gasping or spasmodic breaths, which are shallow and rapid, with pauses between breaths. In contrast, normal breathing is regular and effortless, with each breath being deep and full. Additionally, agonal breathing often occurs during an acute medical emergency, such as cardiac arrest or respiratory failure, while other types of breathing do not.


What is the difference between agonal breathing and gasping?

The difference between agonal breathing and gasping is that agonal breathing usually occurs during a life-threatening medical emergency while gasping is typically a reflexive response to pain or distress. Agonal breathing often involves irregular chest contractions and pauses in respiration, whereas gasping is more of a shallow, rapid inhalation of air. Additionally, agonal breathing can last from seconds to minutes, while gasping usually lasts only a few seconds.


What's the difference between death rattle and agonal breathing?

The death rattle is a sound created when a person is close to death as air passes through their throat and chest. It is usually a gurgling noise that occurs due to a lack of muscle control in the throat. Agonal respiration is a type of unusual and labored breathing seen in a dying person. It usually has a pattern of a few normal breaths followed by a series of irregular breaths, and it is often considered to be a sign that death is imminent.


What is the difference between agonal breathing and COPD?

Individuals with Chronic Obstructive Pulmonary Disease (COPD) may encounter shortness of breath, coughing, and wheezing when engaging in a physical activity requiring exertion.

In contrast to agonal breathing, COPD develops gradually, often due to long-term smoking or exposure to harmful substances. During a severe COPD attack, individuals usually remain alert and capable of normal movement. This observation also holds true for asthma attacks.


What is the difference between agonal breathing and Pulmonary Embolism?

Pulmonary Embolism (PE) denotes an abrupt obstruction of the pulmonary artery, which supplies blood to the lungs. Many individuals afflicted with PE do not display premonitory symptoms leading to developing a significant blood clot. However, once symptoms manifest, they typically entail chest discomfort, difficulty breathing, and the expectoration of blood through coughing. 


What does agonal breathing sound like?

Agonal breathing is characterized by labored noisy breathing with long pauses and gasps. It may sound like gasping breaths, but it can also sound like snorting and labored breathing. It may even seem as though the person is moaning. The abnormal breathing may last for a few breaths or extend to several hours. The cause of agonal respiration will affect the duration and whether there are other symptoms.

How long does agonal breathing typically last?

Agonal breathing typically lasts for a short period of time, usually no longer than several minutes. The duration of agonal breathing depends on the underlying cause and any treatments that are administered. In cases of cardiac arrest, agonal breathing can last up to 10 minutes if CPR is not initiated. If CPR is started immediately, the duration of agonal breathing may be reduced significantly. In cases of respiratory failure, agonal breathing may last for several minutes or longer, depending on the severity of the condition and any treatments that are given.

agonal breathing causes

What Causes Agonal Breathing?

Agonal breathing can be caused by any interruption of the brain's blood supply, depriving it of the oxygen required for its functioning. Possible scenarios which may lead to agonal breathing include:

  • Cardiac arrest: Cardiac arrest occurs when the heart suddenly stops beating. This prevents oxygen-rich blood from reaching the brain and other organs. Cardiac arrest patients usually experience labored, shallow breaths. It is a medical emergency and requires medical attention.
  • Ischemic stroke: Ischemic stroke or cerebral ischemia is the most common type of stroke, accounting for approximately 87% of all strokes. This occurs when an artery that supplies blood to the brain is obstructed.
  • Hemorrhagic stroke: A hemorrhagic stroke is a type of stroke caused by bleeding within or around the brain, which can result in labored breathing characterized by guppy breathing.
  • Anoxic brain injury: An anoxic brain injury is an injury that interrupts the supply of oxygen to the brain, causing damage. Examples of this type of injury include cardiac arrest and ischemic stroke.


Other common causes include:

  • Carbon monoxide poisoning
  • Drowning
  • Suffocation
  • Choking
  • Electrical shock
  • Drug overdose

How does agonal breathing affect the brain and body?

Agonal breathing affects the brain and body by depriving them of oxygen. This can lead to confusion, dizziness, changes in consciousness or coma, and even death if not treated quickly. Additionally, agonal breathing can cause significant damage to the heart, lungs, and other organs due to a lack of oxygen. Agonal breathing can also cause an increase in blood pressure, which may lead to further complications. Therefore, it is important to seek immediate medical attention if someone is exhibiting signs of agonal breathing.

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What role does the autonomic nervous system play in agonal breathing?

The autonomic nervous system plays an important role in agonal breathing. This system regulates the body’s involuntary functions, such as heart rate, respiration, and blood pressure. During a medical emergency such as cardiac arrest or respiratory failure, the autonomic nervous system can become overstimulated which can lead to agonal breathing. Agonal breathing is caused by a series of involuntary muscle contractions in the chest, which are stimulated by the autonomic nervous system.


What are the risk factors for developing agonal breathing?

Certain drugs and medications can increase the risk of agonal breathing due to their impact on the autonomic nervous system. Other risk factors include advanced age, smoking, obesity, and underlying health conditions such as hypertension or diabetes. It is important to be aware of these risk factors so that appropriate medical treatment can be sought if agonal breathing is suspected.

Can agonal breathing occur in individuals who are not dying?

Yes, agonal breathing can occur in individuals who are not dying. Agonal breathing may be caused by a number of factors other than cardiac arrest, such as respiratory failure due to asthma or COPD, extreme physical exertion, drug overdose, or neurological conditions. In these cases, the person may initially experience agonal breathing, but with timely medical intervention and treatment, the individual can often recover.


What are the treatments for agonal breathing?

The treatment for agonal breathing depends on the underlying cause. In cases of cardiac arrest, cardiopulmonary resuscitation (CPR) and defibrillation may be needed to restore a normal heartbeat. For respiratory failure, supplemental oxygen and other treatments may be used to support breathing. Medications such as sedatives or muscle relaxants may sometimes be given to help control breathing.


How can CPR be used to assist with agonal breathing?

CPR (Cardiopulmonary Resuscitation) can be used to help with agonal breathing by restoring circulation and oxygenation to the body. It is important to begin CPR as soon as possible when agonal breathing is present, as it is often a sign of cardiac arrest or respiratory failure. During CPR, chest compressions are used to maintain circulation and help restore oxygen flow to the body. This can help to reduce the severity of agonal breathing and may even restore normal breathing.

You can respond to cases of agonal breaths by providing CPR chest compressions at a rate of 100-120 beats per minute. If available, utilize an automated external defibrillator (AED) to restart the heart of someone in sudden cardiac arrest. Research indicates that cardiac arrest victims exhibiting agonal breathing are likely to benefit most from rapid CPR and defibrillation, increasing their likelihood of survival.


What to Do If Someone Experiences Agonal Respiration?

In the event of someone experiencing agonal respiration, it is important to take prompt action. Below are the steps to follow:

  1. Call for Professional Help: If multiple people are present, ask someone to call 911 for emergency medical assistance, regardless of the situation. If you are alone, call for help while attending to the person. If no one arrives to help you, call 911 for medical help while still tending to the person.
  2. Identify Agonal Breathing: Determine if the person is experiencing agonal breathing by timing the gasps. If they are sporadic and occur less than 13 times per minute, agonal breathing is likely.
  3. Attempt to Communicate with the Person: If you suspect that the person is not experiencing trauma to the neck or spine, gently shake them and try to get a response. If the person responds, they are unlikely to be in cardiac arrest, but it is still important to be prepared for that possibility while awaiting medical help. If they do not respond, check their pulse to see if their heart beats. Remember to look for reflexes caused by the brain stem, not actual responses.
  4. Retrieve and Prepare the AED: If an automated external defibrillator (AED) is available, retrieve it and prepare it for use. These devices are often found in public locations such as businesses, schools, and hospitals.
  5. Begin CPR: Follow the Basic Life Support (BLS) Algorithm or Opioid Overdose CPR guidelines, as appropriate. Use a fast rhythm to maintain chest compressions at a rate of 100-120 per minute. Consider using a song with the appropriate pace, such as "Stayin' Alive" by the Bee Gees.
  6. Follow AED Instructions: If the AED device prompts you to shock the person, follow the instructions and do so. Some AEDs will do this automatically once the pads have been placed.
  7. Continue CPR: If the heart does not restart, continue CPR until the ambulance arrives. Do not stop CPR unless it is clear that the person is recovering. Look for signs such as normal breathing, movement, or responsiveness to touch.

Remember to keep the person awake if they wake up, and seek medical attention as soon as possible.

In addition to CPR, emergency medical services may administer drugs to treat the underlying cause and provide ventilation or intubation if oxygen isn't entering the body properly. These medical treatments are essential for addressing a dangerous cardiac arrest heart rhythm.

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