Advanced Medical Certification

Shopping Cart

No products in the cart.

View All Courses

Gasping for Answers: Understanding Agonal Breathing

Gasping for Answers: Understanding Agonal Breathing

Photo of Greta

by Greta Kviklyte

Life Saver, AMC
Co-authored by Kim Murray, RN, M.S.

posted on Aug 29, 2023, at 8:21 am


If you’ve just found this article, you might have come across a new subject for you – agonal breathing, and now you want to understand it better. In this exploration, we’ll dive deep into the realm of agonal respiration, unraveling its significance, causes, and the crucial understanding it demands.

The term “agonal” itself signifies the potential for extreme suffering, encapsulating the gravity of the situation that unfolds when agonal breathing comes into play. This phenomenon, characterized by desperate gasping for air, usually emerges in the throes of a severe medical crisis, such as a stroke or heart attack.

At first glance, these gasps might appear conscious, but the reality is far more primal.Old woman experiencing agonal breathing Agonal breathing is often an involuntary reflex, orchestrated by the brain stem – the ancient sentinel of survival mechanisms that activate when the higher faculties of the brain remain oblivious to the impending catastrophe. This primal response is the brain’s last-ditch effort to sustain vital functions in the face of impending demise. Notably, this agonizing respiration pattern typically manifests after the heart has ceased its rhythmic dance, leaving the body devoid of the oxygenated lifeblood that sustains it.

Herein lies the urgency – the seconds that become the fulcrum between life and irreversible damage. Amidst the chaotic rhythm of such a crisis, the heart must be revived within a narrow window, or else the repercussions cascade into permanent brain injury and, ultimately, cessation of life. In light of these critical moments, recognizing agonal respiration is tantamount to wielding a shield against impending tragedy. Armed with this knowledge, you possess the ability to bridge the gap between life and death. Learning the essentials of CPR can transmute you into a lifeline, a beacon of hope capable of preserving not just a heartbeat but the essence of existence itself. The journey into the realm of agonal breathing is one fraught with urgency and compassion. It beckons us to awaken our instincts, to educate ourselves about the gravity of these moments, and to stand as sentinels of life in its most fragile state.

How to Recognize Agonal Breathing: Symptoms 

Agonal respiration emerges from the intricate dance between our autonomic nervous system and the body’s dwindling energy reserves. In these dire moments, the brain’s respiratory centers struggle to maintain their hold on a faltering system. The result? Spasmodic breaths that are far from the rhythmic and steady pattern we’re accustomed to.

In our exploration of agonal breathing, a critical aspect lies in its recognition – the ability to identify the signs that mark this harrowing phenomenon. The cues that agonal respiration leaves can serve as a bridge between crisis and intervention, potentially making the difference between life and irreversible consequences.

A defining characteristic of agonal breathing is the sound it produces. The gasps for air are often irregular, raspy, and marked by desperate inhalations. The breaths can mimic deep, laborious efforts, punctuated by intermittent pauses. Unlike the steady, rhythmic breathing we’re accustomed to, agonal breaths carry an urgent and haunting quality, echoing the turmoil within the body. Agonal respiration involves pausing between breaths, contrasting with the quick, short breaths typically seen when someone struggles to breathe. Those experiencing agonal respiration take slow, 10-12 breaths per minute, differing from the average 12-25 breaths per minute of an undistressed individual. Muscle twitching might mislead you into thinking the person’s heart is still beating, but this is likely a reflex response. In short, the sound can be described like this:

  • Gasping
  • Occasionally moaning
  • Snorting
  • Sporadic breathing, not in quick succession

Physical manifestation. Beyond sound, agonal breathing can be observed in physical manifestations. The body may appear rigid or tense as if grappling with the very act of respiration. Notably, the chest might not rise and fall in its usual pattern, underscoring the erratic nature of the gasping.

Facial expression. The face can also provide insights into the distress. Individuals undergoing agonal respiration may display a strained and anxious facial expression. The intensity of the gasping, coupled with the body’s struggle for oxygen, can reflect as an expression of desperation – a silent plea for help.

Oxygen deprivation and color changes. Changes in skin color can be indicative of the severity of the situation. Pallor or a bluish tint to the skin, known as cyanosis, can arise due to inadequate oxygen reaching essential tissues. This alteration in color serves as a stark reminder of the urgency, emphasizing the need for swift action.

Before becoming unconscious, a person may show these visual signs of agonal breathing:

  • Experiencing an intense and excruciating headache
  • Struggling with understanding spoken words
  • Speech becoming unclear and difficult to comprehend
  • Noticing a sagging or asymmetrical facial expression
  • Lack of coordination and balance
  • One side of the body becoming weak or paralyzed

Recognizing agonal breathing isn’t just about comprehension; it’s about a timely response. As mentioned earlier, agonal respiration can swiftly lead to irreversible brain damage if not addressed promptly. With a short window of two to three minutes, before the situation escalates, every moment counts.

Distinguishing Agonal Breathing from Other Respiratory Patterns

For a deeper comprehension of recognizing agonal breathing, let’s delve into certain conditions that might present confusion.

Pulmonary Embolism

Pulmonary Embolism denotes an abrupt obstruction within the pulmonary artery, affecting the lungs. Numerous individuals facing PE encounter a significant clot without any prior symptomatic indications. However, once symptoms arise, they manifest as chest discomfort, respiratory distress, and hemoptysis (coughing up blood).

Death Rattle

A term often used colloquially is “death rattle,” referring to the final breaths preceding a person’s passing. Although similar in appearance and sound to agonal breathing, there are distinct contrasts. The death rattle tends to emit more of a gurgling noise, evoking imagery of fluid accumulating in the lungs. Notably, the death rattle commonly occurs in individuals within the advanced stages of their dying process, often attributed to age or prolonged illness.

In contrast, agonal breathing unfolds unexpectedly, arising from sudden health crises. Unlike the culmination of breath for someone battling a prolonged and terminal ailment, agonal respiration emerges as a result of unforeseen health events. It serves as an urgent signal, a manifestation of a critical health incident that necessitates swift action. Recognizing agonal respiration and promptly seeking medical assistance can potentially alter the course of events, offering a chance for the individual to regain their health and continue to lead a productive life.

COPD Shortness of Breath

Individuals afflicted with Chronic Obstructive Pulmonary Disease (COPD) often experiencebouts of coughing and the sound of wheezing. Unlike the distinctive characteristics of agonal breathing, COPD typically evolves gradually, primarily attributed to prolonged smoking or exposure to hazardous airborne substances. During a pronounced COPD episode, individuals usually remain alert and capable of unhindered movement. This parallel pattern extends to asthma attacks as well.

Lung Cancer Breathing

Individuals grappling with lung cancer often encounter challenges related to lung expansion and exhalation, resulting in episodes of breathlessness. Remarkably, those dealing with lung cancer tend to exhibit heightened awareness, often employing strategies like leaning forward or practicing pursed-lip breathing to alleviate the discomfort and enhance the flow of air.

Most Common Causes For Agonal Respiration

Agonal respiration typically arises as a response to critical medical situations. Some of the most common causes include:

  • Cardiac Arrest: A primary cause of agonal respiration, cardiac arrest occurs when the heart suddenly stops beating effectively, disrupting the flow of oxygenated blood throughout the body.
  • Stroke: During a stroke, the brain’s blood supply is compromised, leading to neural damage. Agonal respiration might manifest as a result of the brain’s attempt to cope with this diminished oxygen supply.
  • Severe Brain Injury: Traumatic brain injuries or other severe brain-related conditions can prompt agonal breathing, as the brain attempts to sustain vital functions in the face of damage.
  • Drug Overdose: In cases of drug overdose, the body’s respiratory centers can be affected, leading to agonal respiration as a result of respiratory depression
  • Hypoxic Events: Hypoxia, a condition characterized by low oxygen levels in the body, can trigger agonal breathing as the brain stem attempts to cope with reduced oxygen availability.
  • Respiratory Failure: Agonal breathing can emerge when the respiratory system fails to adequately supply the body with oxygen, often seen in conditions like acute respiratory distress syndrome (ARDS).
  • Terminal Illness: Agonal respiration might be witnessed in individuals with end-stage terminal illnesses, especially when they’re nearing the final moments of their lives.

It’s crucial to remember that agonal breathing is a sign of severe medical distress, requiring immediate medical attention. If you suspect someone is experiencing agonal respiration, it’s important to seek professional medical help promptly.

It’s especially important for professionals working in close proximity to groups of people to learn what to do if someone starts agonal breathing.

Timeline Of Agonal Breathing

Statistics indicate that a person’s chances of survival diminish by approximately 10% with every passing minute without a heartbeat. When agonal respiration is present, an individual might endure for around five minutes, beyond which revival remains possible. However, beyond this critical timeframe, a cascade of consequences unfolds. Within five minutes of oxygen depletion, brain cells begin to perish, and in merely 10 minutes, substantial damage can afflict vital organs and the brain.
Given the average 14-minute wait time for an ambulance to arrive and the sobering statistic that 10% of Americans await an ambulance for at least 30 minutes, the act of dialing 911 and then awaiting assistance is unlikely to secure the person’s life. However, in this challenging scenario, you hold the potential to exert control, championing life preservation and safeguarding cognitive function.

What Can You Do Then?

In such a situation the best help would be if you would be knowledgeable in first aid and CPR. However, prior to aiding individuals, it remains paramount to safeguard your own safety. Therefore, before launching into the CPR protocol, a crucial initial step is to secure the scene’s safety. Regardless of intent, intervening in an unsafe environment might inadvertently exacerbate the situation, leading to additional risks. Tailoring the safety assessment to the specific location of the incident is imperative to this process. We have got you covered with a detailed overview of CPR steps in this article.

Here are the main CPR steps that you can use as a reference when you are already equipped with these skills:Performing CPR

  • Call 911 for an ambulance
  • Determine if this is agonal breathing
  • Find an AED/defibrillator machine
  • Access pulse
  • Start chest compression
  • Administer breaths at 5 to 6-second intervals
  • Access for shockable rhythm

The important rule when doing CPR – if the heart has not restarted, continue CPR until the emergency team arrives. Once you have started CPR, you must not stop doing it unless you are completely sure that the person has returned to a normal state.

Empowerment Through CPR Training

The ability to identify agonal breathing is more than awareness – it’s empowerment. By recognizing the symptoms and discerning the signs, you hold the power to become a potential lifesaver. Armed with this understanding, you can be a lifeline in moments of crisis, offering assistance, reassurance, and the potential for recovery when it’s needed most.

Emergencies demanding CPR expertise aren’t confined to a single realm. Individuals from various walks of life – nurses, teachers, daycare administrators, even company managers – may find themselves facing such scenarios. Acquiring CPR training not only equips you with vital life-saving skills but also instills the self-assuredness essential for the task. In those critical moments where every second counts, this confidence ensures you know precisely what to do while maintaining a composed demeanor.

Moreover, obtaining certification presents a compelling addition to anyone’s resume. Hiring managers value employees who possess emergency-response capabilities. In certain professions, being certified might even amplify earning potential or stand as a prerequisite to upholding certification status. At Advanced Medical Certification, our  CPR, AED & First Aid Certification program adhere steadfastly to the widely recognized ILCOR standards and guidelines. With Joint Commission Compliance and a national recognition rate of 98%, you can trust our training. Armed with this 100% online training course, you’ll be prepared to tackle agonal respiration emergencies and a myriad of related situations.

Have you already had a situation where a person nearby has experienced agonal breathing? Share your experience in the comments section below.

About Greta

Greta is a dedicated life saver and a distinguished expert in the field of medical content creation and editing. Her impressive array of certifications in ACLS, CPR, PALS, and BLS underscores her commitment to excellence in the medical field. With over four years of invaluable experience in medical education, Greta plays an indispensable role within the Advanced Medical Certification team, shaping the way healthcare professionals around the world acquire and apply vital knowledge.

Greta's profound expertise serves as the driving force behind the development and distribution of medical content that has significantly enhanced the capabilities of countless healthcare practitioners across the globe.

In addition to her medical qualifications, Greta holds a prestigious academic distinction in Marketing and Global Business from Vilnius University. Her academic journey has been enriched by immersive studies in Slovakia and Portugal during her time as an exchange student, providing her with a global perspective that complements her medical expertise.

Beyond her professional commitments, Greta possesses a genuine passion for global exploration, with a particular focus on immersing herself in diverse cultures and appreciating the intricacies of the natural world. While residing in Vilnius, Lithuania, she continues to make substantial contributions to the field of medical education, leaving an indelible mark on the sector.

Reach out to Greta at


Leave a Reply

Your email address will not be published. Required fields are marked *