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Agonal respiration is an abnormal pattern of breathing and brainstem reflex characterized by gasping and gulping breaths that are accompanied by strange vocalizations.

Agonal respiration is one sign of respiratory and cardiac arrest. Historically, this type of breathing has been difficult to identify and describe, especially for lay people, which can slow or hinder care and response times for cardiac arrest victims.

A Word About Cardiac Arrest

Cardiac arrest occurs when the heart stops beating or beats too ineffectively to circulate blood to vital organs, including the brain. When heartbeats are weak, irregular, or uncoordinated, blood can't flow through the arteries to the rest of the body.

If circulation is hampered or halted in any way, the body's organs cannot receive the oxygen they need to function normally. As a result, organ failure can occur. Brain damage sets in between 4-6 minutes, and after 8-10 minutes, this damage will likely be irreversible.

Cardiovascular disease is the leading cause of death in the world and in the U.S., where it accounts for approximately 1 in 3 deaths. Cardiovascular disease is also the primary cause of cardiac arrest, but there are others, including:

  • Drowning
  • Choking
  • Drug overdose
  • Severe injury
  • Brain damage
  • Electrocution

Warning: As more than 300,000 out-of-hospital cardiac arrests occur each year in the U.S., it's vital that lay people and EMS professionals understand that early recognition – which is more difficult with agonal respiration – and quick action can have a tremendous impact on survival rates.

Cardiac Chain of Survival

To effectively respond to cardiac emergencies, it helps to understand the Cardiac Chain of Survival. Following the links in these chains – adult and pediatric – will give patients the best chance of survival.

Warning: For each minute that CPR and/or defibrillation are delayed, the chance of survival is reduced by 7-10 percent.

Adult Cardiac Chain of Survival

  • Recognize the emergency and call 911 – the sooner medical personnel are called the sooner EMS can provide care for the patient.
  • Early CPR – supplying blood and oxygen to vital organs can prevent brain damage and death.
  • Early defibrillation – this electrical shock may restore an effective heart rhythm and increase the victim's chance of survival.
  • Advanced life support – Medical personnel can help provide the proper equipment and medication needed to continue lifesaving care.
  • Integrated post-cardiac arrest care – Integrated care can optimize ventilation and oxygenation and treat hypotension immediately after the return of spontaneous circulation.

Pediatric Cardiac Chain of Survival

  • Injury prevention and safety – ways to prevent cardiac arrest in children.
  • Early CPR
  • Early Emergency Care – Rapid activation of the EMS system or response team to get help on the way quickly.
  • Pediatric advanced life support
  • Integrated post-cardiac arrest care

Agonal Respiration Continued

Agonal respiration is characterized by abnormal breathing attempts in which the patient appears to be gasping or gulping. (Think of a fish as it tries to breathe out of water to get an idea of what agonal respiration looks like.) These respiratory attempts originate from the lower brain stem neurons as higher, more complex neurons become increasingly hypoxic – lacking in oxygen.

Agonal Respiration occurs in around 40 percent of early cardiac arrest victims. Aggressive CPR attempts are often hindered or slowed due to misinterpretation or misunderstanding of this serious condition.

Pro Tip #1: It's important to remember that, when it comes to agonal respiration, these attempts from the body to breathe are routinely misinterpreted as normal breathing. However, even though it may appear the victim is breathing, he or she is not exchanging air well and will require immediate assistance to increase his or her survival rate.

While lay people describe agonal respiration a number of ways, the good news is that 911 dispatchers have become better equipped to recognize all the ways in which people describe it, leading to better assistance and improved response times.