Agonal breathing is the medical term used to describe struggling to breathe or gasping. It is often a symptom of a severe medical emergency, such as stroke or cardiac arrest.

The gasping associated with agonal breathing is not true breathing, but rather a brainstem reflex. Agonal breathing often occurs because the heart is no longer circulating oxygen-rich blood. In other cases, it may be due to the lungs not bringing in enough oxygen.

If a person starts agonal breathing, they should get to the hospital or receive emergency medical intervention immediately, unless they are in a setting intended for the end of their life. Though not always the case, agonal breathing may indicate death is imminent for the individual.

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Agonal breathing requires immediate medical intervention.

Agonal breathing can last up to several hours, or it may only consist of a couple of breaths.

Agonal breathing can sound like:

  • gasping
  • snorting
  • labored breathing
  • possibly moaning

A person may also show some signs of twitching muscles during agonal breathing.

Ultimately, the cause of agonal breathing determines how long it lasts and what other symptoms accompany it.

Agonal breathing is often the result of cardiac arrest or stroke. During an episode of agonal breathing, a person may lose consciousness.

Some additional symptoms that can occur if a person is having a stroke include:

  • poor coordination
  • a drooping face
  • rapid onset headache
  • inability to speak clearly
  • half the body becoming weak
  • inability to understand others when they speak

Agonal breathing is sometimes confused with a different phenomenon referred to as "death rattle." Death rattle is more of a gurgling noise caused by mucus or saliva that is caught in the chest as a person is dying. By contrast, agonal breathing is an often brief period of abnormal breathing.

There are some other types of breathing that may also be mistaken for agonal breathing. Labored breathing is different in that air is still making its way to the brain. Some common causes of labored breathing include:

Agonal breathing has two primary causes: cardiac arrest and cerebral ischemia, which is a type of stroke caused by a reduction of oxygen-rich blood reaching the brain.

Cardiac arrest creates problems with the heart's electrical system. This problem causes a person's heart to beat irregularly, called arrhythmia.

During cardiac arrest, the heart will continue to pump blood and oxygen to the brain and other vital organs for a short time. However, the lack of oxygen will cause the person to gasp for breath. Typically this lasts for only a few minutes.

According to the American Heart Association, if a person has a heart attack, they are more likely to develop cardiac arrest.

Two types of stroke may cause cerebral ischemia:

  • a hemorrhagic stroke which is caused by a bleeding blood vessel on the brain
  • a mini-stroke which is caused by a blocked blood vessel within the brain

However, any condition that blocks blood from reaching the brain can cause cerebral ischemia. If cerebral ischemia lasts for too long, the lack of oxygen can lead to permanent brain damage.

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A person who has gone into cardiac arrest may require CPR.

If a person starts to gasp or have difficulty breathing, they are showing signs of a serious underlying condition and will require immediate treatment.

If someone begins to gasp for air, a person with them should call emergency services straight away. Tell the operator about any symptoms and describe the gasping or breathing trouble that the person is displaying.

It is essential to treat agonal breathing immediately.

A person who goes into cardiac arrest will often slump or fall to the ground. If this happens, perform CPR chest compressions on the person until paramedics arrive. If unsure how to do CPR, ask the dispatcher for steps of what to do.

In some situations, a person having cardiac arrest may be revived using an automated external defibrillator (AED). If this is not available, chest compressions are the best option.

If CPR and an AED are not effective in restoring the heart's normal rhythm, doctors will likely use a mechanical ventilation machine to help to restore breathing and proper heartbeat.

After restoring the heartbeat, doctors will often prescribe medications to help maintain a healthy blood pressure.

Agonal breathing can be fatal due to a lack of oxygen reaching the brain. Sometimes, people can save a person's life by performing chest compressions while help is on its way.

Once paramedics arrive, they will often be able to preserve the heart, brain, and other vital organs while stabilizing the individual.