what does agonal breathing sound like
Agonal breathing may sound like gasping, snorting, heavy or labored breathing, gurgling, or groaning. Learn about causes and treatment

Agonal breathing may sound like:

  • Gasping
  • Snorting
  • Heavy breathing
  • Labored breathing
  • Gurgling
  • Groaning

Gasping associated with agonal breathing is a brainstem reflex and not true breathing. The gasping is caused solely by residual nervous system activity and is very shallow.

What is agonal breathing?

Agonal breathing or agonal respiration is the medical term for the gasping that occurs when someone is struggling to breathe because of a serious medical emergency. Desperate gasping for air is usually a sign that the heart is no longer circulating oxygenated blood to the body or that lung activity has been disrupted, reducing oxygen intake. It is an indication that the person needs cardiopulmonary resuscitation.

Agonal gasping is usually accompanied by snoring-like sounds and possibly a slight shrug of the shoulders. This breathing pattern should be interpreted as a sign that a person does not have a pulse. It is best to treat the person as if they are not breathing at all, since there is no air entering the lungs, and no true gas exchange occurs within the lungs. 

People who present with agonal gasping have a better chance of recovery than those who present with apnea (no respiratory effort at all). They are more likely to be in ventricular fibrillation and have a shorter cardiac arrest time.

What are symptoms that accompany agonal breathing?

The cause of agonal breathing ultimately determines how long it lasts and what other symptoms accompany it. During agonal breathing, a person may exhibit some signs of muscle twitching. 

Signs and symptoms that may precede agonal breathing include:

  • Weakness on one side of the body
  • Facial droop
  • Lack of coordination
  • Poor speech or an inability to understand speech
  • Sudden headache

This abnormal breathing pattern may last only a few breaths or for hours. It is possible that the individual will lose consciousness while gasping.

If a person begins to experience agonal breathing, they may need immediate emergency medical attention, unless they are in a setting intended for the end of their life. In some cases, agonal breathing may indicate that the individual's death is imminent.

What causes agonal breathing?

Cardiac arrest

Cardiac arrest disrupts the electrical system of the heart. It causes a person's heart to beat irregularly (arrhythmia).

  • During cardiac arrest, the heart continues to pump blood and oxygen to the brain and other vital organs for a brief period. However, lack of oxygen causes the person to gasp for air. This usually only lasts a few minutes.
  • According to the American Heart Association, a person who has a heart attack is more likely to have cardiac arrest.

Cerebral ischemia

Cerebral ischemia is a type of stroke caused by a decrease in the amount of oxygen-rich blood reaching the brain. It can be caused by two types of strokes:

  • Hemorrhagic stroke, which occurs when a blood vessel in the brain bleeds.
  • Mini stroke, which is caused by a clogged blood vessel in the brain.

Cerebral ischemia can be caused by any condition that prevents blood from reaching the brain. If cerebral ischemia continues for an extended period, lack of oxygen can result in permanent brain damage.


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How is agonal breathing treated?

A person who has gone into cardiac arrest may require cardiopulmonary resuscitation (CPR). When a person has cardiac arrest, they will frequently slump or fall to the ground. If this occurs, perform CPR chest compressions on them until a paramedic arrives. If you are unsure how to perform CPR, ask a 911 dispatcher for instructions.

In some cases, a person in cardiac arrest may be revived by an automated external defibrillator (AED). If this is not an option, chest compressions are the next best thing.

If CPR and an AED are ineffective in restoring the heart's normal rhythm, doctors will most likely use a mechanical ventilation machine to aid in the restoration of breathing and proper heartbeat. Following the restoration of the heartbeat, doctors will frequently prescribe medications to aid in the maintenance of healthy blood pressure.

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Medically Reviewed on 11/2/2021
Image Source: RealPeopleGroup / Getty Images

What to Know About Agonal Breathing: https://www.webmd.com/heart-disease/what-to-know-agonal-breathing

The agony of agonal respiration: is the last gasp necessary? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1733591/

WHAT YOU NEED TO KNOW ABOUT AGONAL BREATHING: https://www.aed.com/blog/what-you-need-to-know-about-agonal-breathing