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Agonal Breathing: Causes, Symptoms, Prognosis, When To Seek Help

What is Agonal Breathing?

Agonal Breathing is a term that is used to describe a condition where a person is struggling to breathe and is gasping for air. This is generally a symptom of a cardiac arrest or a stroke. It is a medical emergency and if treatment is not given then in most cases it leads to loss of life of the person. The gasping that is seen in people with Agonal Breathing is in actuality not a true breathing process but is rather a brainstem reflex action that is occurring suggesting that the heart is unable to pump oxygen to the brain and other vital organs of the body.[1,2,3]

Agonal Breathing: Causes, Symptoms, Prognosis, When To Seek Help

A person with noticeable Agonal Breathing should be taken to the emergency room immediately unless the person already has an advanced terminal illness and is a DNR. In most cases Agonal Breathing is a sign of imminent loss of life. The duration of Agonal Breathing is variable. While in some cases it may be just for a couple of breaths, in other cases it may be prolonged and last for a few minutes to even in some cases an hour. Agonal Breathing is quite easy to recognize from other respiratory patterns.[1,2,3]

What Causes Agonal Breathing?

As stated, Agonal Breathing is caused by cardiac arrest and stroke which is medically termed as cerebral ischemia. This is condition in which the oxygen does not reach the brain. Cardiac arrest occurs when the electrical system of the heart fails causing the heart to beat irregularly which in medical terms is called arrhythmia.[3]

In a person with cardiac arrest, the heart continues to pump in oxygen to vital organs of the body including the brain for a short period of time during which the person experiences gasping or Agonal Breathing. However, this is only for a few minutes after the heart completely shuts down causing loss of life unless resuscitation measures are taken immediately.[3]

The American heart Association states that a person with a past history of myocardial infarction is most at risk for a cardiac arrest. With regard to stroke, there are two types of stroke which can cause cerebral ischemia of which one is hemorrhagic stroke that is caused by internal bleeding of a vessel in the brain. The second type is the mini stroke which is caused by a blocked vessel in the brain that interrupts the blood supply. If cerebral ischemia lasts for excessive amount of time it can cause irreversible damage to the brain.[3]

What Are The Symptoms of Agonal Breathing?

As stated, the duration of Agonal Breathing is variable. In some cases it may just be a couple of breaths and in others it may last for a few minutes to an hour. The patient will sound as if he or she is gasping for air. A snorting sound will also be heard. Some people also may moan while breathing during Agonal respirations.[3]

In some cases, muscle twitching is also observed in a person having Agonal Breathing. The person will then lose consciousness. Additionally, Agonal Breathing can be accompanied by poor coordination, facial drooping, sudden onset acute headache, and inability to hear or comprehend clearly.[3]

When To Seek Help For Agonal Breathing?

Agonal Breathing is an emergent medical condition and requires treatment almost immediately. Even a delay of a minute may cost the life of the person. The first thing to do when a person starts to show Agonal Breathing is to call 911 and get immediate help. The symptoms should be described in detail to the operator so that they understand the gravity of the situation.[3]

A person with Agonal Breathing will almost immediately collapse to the ground in cases of a cardiac arrest. In such a scenario, immediate CPR and chest compressions should be started at the rate of 100 compressions a minute. If there is an automated external defibrillator available then that should be used immediately. If both of these are not effective then the patient may have to be put on mechanical ventilation to get the heartbeat back to normal.[3]

What Is The Prognosis Of Agonal Breathing?

Agonal Breathing in most cases is a sign that the person is going into cardiac arrest or stroke and both of these conditions are fatal as in both these conditions the brain does not receive oxygen. The prognosis is such situations are quite poor and loss of life occurs within minutes unless treatment is provided in the form of defibrillator or if chest compressions and CPR work while emergency services are on their way.[3]

If the patient survives till the paramedics arrive then they will be able to help in preserving the function of the heart and brain along with other vital organs of the body and restore back normal heartbeat.[3]


Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:April 11, 2022

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