Agonal breathing or agonal respiration is a unique pattern of breathing that eventually leads to apnea. This type of respiration is notably different from typical breathing patterns, involving distinct sounds and occurring alongside several other symptoms. Many conditions may trigger episodes of agonal breathing, each of which is life-threatening.

Sounds and Signs

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.

woman checking on an unconscious man


Breathing Rate

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.

woman calling 911 for an unconscious man



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.

x-ray illustration of a cardiac stroke


Agonal Breathing and Cardiac Arrest

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.

checking the pulse of an unconscious man on the street


Coexisting Symptoms

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

older man experiencing an intense headache


Agonal Breathing vs. Other Breathing Issues

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.

man helping an older woman who is having trouble breathing


Agonal Respiration Duration

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.

man unconscious in the hospital


Managing Agonal Breathing

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.

bystander performing chest compressions CPR on an unconscious man


Information for Caregivers

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.

worried woman calling 911 about her husband



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.

older man at home with an oxygen tank


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