Signs, Causes, and Management of Agonal Breathing

Agonal breathing often sounds similar to gasping, though it may also sound like snorting or labored breathing. In some cases, the person having an agonal breathing event will moan. Their breathing may also be sporadic with significant pauses between each breath. Certain muscles may begin to twitch, which is usually a reflex rather than a conscious movement.

Most people can easily recognize the difference between typical breathing and agonal breathing unless a person's normal pattern is deep and slow. The typical respiratory rate of a resting adult is 12 to 20 breaths each minute. A person experiencing agonal respiration tends to breathe much slower, around 10 to 12 breaths a minute.

Agonal breathing has several possible causes. Cerebral ischemia occurs when the brain does not receive enough blood to meet the body’s metabolic demand. Inadequate oxygen supply to the body’s tissues — hypoxia — may also be responsible. In some instances, total depletion of oxygen in the body, called anoxia, is the cause.

While not the direct triggers, cardiogenic shock or cardiac arrest often involve agonal breathing. Nearly 40% of cardiac arrests outside of a hospital environment feature it, as well. The presence of agonal breathing with these conditions generally indicates a better outcome than cases of cardiac arrest without it. However, if a person is unresponsive or has no pulse during cardiac arrest, agonal breathing is not effective breathing.

Usually, a person with agonal breathing is unconscious. If they are conscious, they will typically lose consciousness as the episode continues. During that period of consciousness, other symptoms may occur alongside agonal respiration. These are usually symptoms of conditions like stroke or cardiac arrest:

• Extremely painful headache
• Slurring speech
• Inability to understand other people’s words
• Weakness or loss of mobility on one side of the body
• Lack of coordination
• facial drooping

People, even physicians, often mistake agonal breathing for several other respiratory issues. The death rattle, a layman’s term for the moments of breathing before death, is nearly identical to agonal breathing. However, the death rattle is the result of fluid build-up due to an inability to swallow.

Agonal breathing is essentially the body’s final effort to gain oxygen and is usually not an effective form of breathing. Some experts incorrectly use the term “agonal respiration” to refer to any breathing pattern accompanying organ failure.

Agonal respiration is a sign of life-threatening issues that require immediate medical care. This labored breathing can quickly progress to complete apnea and death. Agonal respiration may persist for several hours, though it may also be as brief as just a few breaths. In some instances, agonal breathing may continue well after a person’s heart has stopped beating.

Treatments for agonal breathing usually focus on restoring normal heart and breathing rates. Automated external defibrillators (AEDs) are among the most common tools for restoring a healthy heart rhythm. Mechanical ventilation may be necessary to introduce more oxygen into the body. Chest compressions can be performed until the ambulance arrives.Mouth-to-mouth resuscitation is not recommended because it can interfere with blood flow to the heart.

Because of the potential outcomes, immediately seek medical attention during any potential episode of agonal breathing. Calling emergency services is the best choice as emergency personnel can perform life-saving treatment on the way to the hospital. Receiving training in CPR can help during cardiac arrest, though it is best to call 911 and receive instruction from the operator in each case.

Agonal breathing is usually the result of a deadly condition and requires immediate attention. Depending on the triggering issue, a person with agonal breathing can recover if they receive emergency care. Conditions like hypoxia may require the use of oxygen at home. However, if a condition cuts off oxygen for longer than a few minutes, it is unlikely that the individual will recover fully.