How to Recognize Agonal Breathing

A Potentially Serious Breathing Pattern That Sounds Raspy

Updated on April 01, 2024

Medically reviewed by Sanja Jelic, MD

Agonal breathing is the body's last attempt to stay alive before death. It is an automatic response caused by the central nervous system to try to regain stability inside the body. Agonal breathing sounds like a person gasping for air.

This article will describe the causes, symptoms, and treatments for agonal breathing. Because this condition usually occurs when someone is near death, it will also discuss end-of-life concerns, palliative care, and support.

Close up shot of son holding father's hand at the hospital — FG Trade / Getty Images

Agonal Breathing Symptoms and Characteristics

Recognizing the symptoms of agonal breathing is important because it is a sign of a medical emergency. A timely intervention could save someone’s life, depending on why agonal breathing occurs.

The symptoms of agonal breathing include:

Eyelids, hands, or feet may twitch involuntarily
Gurgling sounds in the throat
Loss of consciousness
Shortness of breath, with chest rising and falling
Speech may be slurred during the struggle to get air

A Word From Verywell

Agonal breathing is an emergency. Call for appropriate help immediately if you notice someone with agonal breathing.

— SANJA JELIC, MD, MEDICAL EXPERT BOARD

Emergency Steps If You Suspect Agonal Breathing

If you think someone is experiencing agonal breathing, seek help right away. Tell a healthcare provider what is happening if you are in a hospital or hospice setting. Outside of a healthcare setting, call 911 immediately.

Agonal Breathing Causes

Many conditions, including the following, can lead to agonal breathing due to lack of oxygen:

Cardiac arrest: During cardiac arrest, blood stops flowing to the brain and organs.
Stroke: A stroke is caused by a blockage or rupture in a blood vessel that carries blood to the brain, thus disrupting or blocking the flow of oxygen.
Airway obstruction: Any object that blocks the windpipe will prevent breathing and loss of oxygen.
Pulmonary embolism: A pulmonary embolism happens due to a sudden blockage in a lung artery, usually from a blood clot.
Approaching death: As the body begins to shut down, oxygen levels decrease.

Agonal Breathing Treatment

If agonal breathing occurs during the onset of an unexpected health event, quick medical intervention can save a life. It can also happen during the last stages of a terminal illness. In this case, medical attention is only necessary for symptom relief.

Waiting for Help

If agonal breathing is occurring due to a sudden health event, such as a stroke or cardiac arrest, it’s essential to call 911 immediately. The brain is extremely sensitive to lack of oxygen, and it takes less than five minutes for cells to start dying when they are deprived of oxygen.

Perform cardiopulmonary resuscitation (CPR) until an emergency medical team arrives.

At the Hospital

If someone you're visiting in a hospital experiences agonal breathing, get a healthcare provider immediately. Swift action is necessary in the case of cardiac arrest or stroke.

In terminally ill people, agonal breathing is a sign of approaching death. Healthcare providers will decide how best to manage the situation.

Role of CPR Familiarity

CPR is a method for helping keep blood flow moving in the body when an event stops it, or someone stops breathing for any reason. This temporary measure keeps blood and oxygen flowing until emergency medical help arrives.

Administering proper CPR as soon as possible can help save someone’s life and prevent brain damage.

Agonal Breathing and End-of-Life Concerns

When associated with approaching death due to a terminal illness, agonal breathing is normal. However, it can be distressing to witness a loved one gasping for breath and wonder if they are suffering.

While it is disturbing to observe, researchers have concluded that people experiencing agonal breathing are unconscious and, therefore, do not feel pain or discomfort.

Agonal Breathing vs. Death Rattle

Sometimes, the terms "agonal breathing" and “death rattle” are used interchangeably. But they are different conditions and happen under different situations.

A death rattle happens days or hours before death and is heard when saliva pools in the back of the throat due to relaxed throat muscles. Agonal breathing is a natural reflex that happens when your body is not getting enough oxygen.

Support and Palliative Care for Individuals and Families

Palliative medicine is the delivery of care to people who have a terminal illness. The goal of treatment is to provide peace and comfort. This may include:

Assisting loved ones so they can be close to the dying person
Offering emotional support for the dying person and their loved ones
Relieving symptoms, which may include pain or agonal breathing

Summary

Agonal breathing is the body’s last attempt to stay alive. Treatment for agonal breathing must happen as soon as possible to prevent death or brain damage from loss of oxygen. If you witness agonal breathing, start CPR and call 911 immediately.

Agonal breathing also occurs at the end of life and is a natural part of the dying process. During this time, a person may be receiving palliative treatment to ensure they pass as comfortably as possible.

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