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Agonal Breathing: Everything You Need to Know

By knowing how to recognize agonal breathing, you could save someone’s life.  Agonal breathing is a sure sign of cardiact arrest (or another serious medical emergency). Identifying this telltale sign, you can activate the chain of survival that is essential for saving lives. 

But what is Agonal Breathing and what are agonal respirations? How do you recognize agonal breathing? In this article, we are going to discuss everything you need to know about agonal breathing and what to do if you’re in a situation where it occurs.  You don’t have to be a trained medical professional to help save a life from cardiac arrest!

Agonal Breathing Definition

Agonal breathing or agonal respirations are medical terms used to describe insufficient breathing that often sounds like snoring, snorting, gasping, or labored breathing. The person will appear to be choking or having an involuntary gasp reflex. Agonal breathing is not true breathing and often indicates that someone is suffering from a severe medical emergency like cardiac arrest. 

During sudden cardiac arrest, victims may demonstrate agonal breathing for second to minutes after their heart has stopped beating. It is essential to know that agonal breathing is NOT normal breathing and requires your immediate action. Keep reading to learn what you should do in response to agonal breathing.

How Does Agonal Breathing Look?

As described previously,  agonal breathing involves short gasps of air. It’s important to remember that agonal respirations are not normal breathing and are  more like strange, shallow half-breaths. The agonal breathing sound is a lot like snorting or labored breathing.

When someone in cardiac arrest is breathing agonally, they will also be unconscious and not responsive. It is essential that you do not mistake agonal breathing for real breathing and respond to cardiac arrest victims in need.

What Causes Agonal Breathing?

Despite looking like a respiratory problem, cardiac or heart problems can cause agonal respirations. For example, during cardiac arrest, the heart will stop beating effectively due to a problem in the heart’s electrical system. Without a proper heartbeat, the heart cannot distribute oxygen throughout the body. Agonal breathing happens in approximately 40% of persons suffering from sudden cardiac arrest when the lower brainstem gets deprived of oxygen and produces an nonvoluntary breathing reflex. No single descriptor can consistently describe all presentations of agonal breathing, but a collection of terms such as snoring, gasping, snorting, or deep breathing can describe these abnormal respirations. 

Other conditions and emergencies that can cause agonal breathing include cerebral ischemia and hemorrhagic stroke. These situations involve restricting blood flow to the brain and leading to the body desperately trying to intake oxygen via  a nonvoluntary agonal respiration reflex.

How to Respond to Agonal Breathing

If you encounter someone demonstrating agonal respirations, and is unresponsive, you need to immediately respond with Call-Push-Shock which involves three steps:

  1. Call 911 
  2. Perform hands-only CPR by pushing hard and fast on the center of the chest
  3. Use an AED 

[Fig 3 – insert Call Push shock diagram like this example]

Call Push Shock

The very first thing you should always do is call an ambulance immediately. Agonal breathing indicates a severe medical condition that you should treat urgently. If you respond quickly, you can help save a life.  

After contacting an emergency number, immediately perform CPR and use an AED if available. Research indicates that victims of cardiac arrest who demonstrate agonal breathing are some of the most viable patients with a greater likelihood of survival if they receive rapid CPR and defibrillation.

CPR

The very first thing you should always do is call an ambulance immediately. Agonal breathing indicates a severe medical condition that you should treat urgently. If you respond quickly, you can help save a life.  

After contacting an emergency number, immediately perform CPR and use an AED if available. Research indicates that victims of cardiac arrest who demonstrate agonal breathing are some of the most viable patients with a greater likelihood of survival if they receive rapid CPR and defibrillation.

How to Do CPR Infographic

AED

Automated external defibrillators can read a person’s heart rhythm, and if they are suffering from a lethal cardiac arrest arrhythmia, the AED machine will deliver a safe and lifesaving shock to restart their heart. This shock can restart the heart and cause it to beat normally again, saving a person’s life. You don’t need to have medical training to use an AED. The device will give you audio instruction and tell you exactly what to do as described below.

[Fig 5 – AED diagram from the Call Push Shock page]

How to Use An AED Infographic - 2

Additional Treatment for Agonal Breathing

Agonal breathing is a severe condition and is treated on the scene by paramedics. They will take over performing CPR and probably the AED machine as well, depending on the patient’s condition. These are essential treatments for a person in sudden cardiac arrest since defibrillation shocks from an AED are the only way to restart the heart of someone suffering from a dangerous cardiac arrest heart rhythm. Some incubation or ventilation type might also be necessary if oxygen still isn’t correctly entering the body. Medics may also administer drugs to help address the root cause of agonal breathing. 

Learn How to Save A Life from Sudden Cardiac Arrest

Frequently Asked Questions About Agonal Breathing

What is the difference between Agonal Gasps and a Seizure?

Agonal gasps are involuntary and insufficient respirations that are caused by low oxygen in the blood, also known as hypoxia. This breathing is not normal breathing and indicates that someone is likely dying. Agonal breaths can be associated with some shaking or other muscle movement due to the struggle for oxygen. These respirations will sound like snoring, snorting, gasping, or deep breathing. 

By contrast, seizures are caused by abnormal electrical activity in the brain. There are many types of seizures, and depending on the type, people may exhibit uncontrollable, spastic movements of body, particularly the arms and legs, stiffenig and then loosening of limbs or muscles, loss of consciousness, staring into space, confusion, sweating and nausea, or rapid blinking. 

Since cardiac arrest victims may also exhibit abnormal movements, it is important to not falsely confuse cardiac arrest with a seizure because waiting to respond dramatically decreases the chance a person will survive. If someone is unresponsive and not breathing normally, immediately call 911, start hands-only CPR, and use an AED if available. 

Are Athletes at Risk for Agonal Breathing?

Cardiac arrest is both common and unpredictable. Even athletes, who are usually regarded as healthy, are at risk for this dangerous condition. . In fact, exercise can transiently increase risk of cardiac arrest.  

Cardiac arrest during exercise can affect athletes of all ages. If you see someone collapse suddenly on the field or court, especially if it is a non-traumatic collapse, immediately assume it is a cardiac arrest. If they are unconscious or not responding, immediately begin CPR because agonal respirations and continued respirations can frequently appear in athletes. Acting promptly can save a life.

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