Agonal breathing overview vector

Agonal Breathing: Causes, Symptoms, and Treatment (2024)

by | Updated: Apr 28, 2024

Agonal breathing is a critical sign often witnessed in emergency medical situations, indicative of severe physiological distress.

Characterized by irregular, gasping breaths, it is typically associated with conditions that severely impair oxygenation to the brain, such as cardiac arrest or major trauma.

This article provides a comprehensive overview of agonal breathing, exploring its symptoms, causes, and the immediate actions required to address this critical respiratory pattern.

What is Agonal Breathing?

Agonal breathing is an abnormal and often labored breathing pattern characterized by gasping, irregular breaths. It typically indicates severe distress, often seen in medical emergencies like cardiac arrest. This form of breathing is a critical sign that the brain is not receiving enough oxygen.

Agonal breathing vector illustration


Agonal breathing can be caused by several serious conditions, including:

  • Cardiac Arrest: This is the most common cause, where the heart stops beating effectively.
  • Stroke: Interruption of blood supply to the brain.
  • Brain Injury: Trauma leading to damage of brain structures.
  • Respiratory Arrest: Severe failure of the respiratory system.
  • Drug Overdose: Particularly from opioids, which depress breathing.
  • Hypoxia: Low oxygen levels in the blood, possibly from choking or suffocation.

Note: Each of these conditions disrupts the normal respiratory drive or brain function, leading to agonal breathing.

Signs and Symptoms

Agonal breathing is a distinctive and alarming symptom in itself, often recognized by the following characteristics:

  • Gasping: Sharp, sudden intakes of breath that may sound like snorting.
  • Irregular Breathing: Breaths are not rhythmic or regular but sporadic and erratic.
  • Noisy Breathing: Sounds such as gurgling or rattling can accompany breaths due to fluid in the airways.
  • Minimal Air Movement: Despite efforts to breathe, very little air may actually be moving in and out of the lungs.
  • Straining Muscles: Visible struggling or use of neck and chest muscles to breathe.

Note: These signs indicate a critical condition requiring immediate medical intervention.


Diagnosing agonal breathing typically occurs in an emergency setting, often observed by first responders or medical personnel.

Here’s how it is identified:

  • Visual Assessment: Healthcare professionals or trained bystanders can identify agonal breathing by observing irregular, gasping breaths and minimal chest movement.
  • Listening: Noisy, irregular breathing sounds can also be a key indicator.
  • Checking Responsiveness: A person exhibiting agonal breathing often shows reduced or no responsiveness to external stimuli.
  • Pulse Check: Absence or irregularity of pulse can accompany agonal breathing, especially in cases like cardiac arrest.
  • Monitoring Devices: In a hospital setting, respiratory rate monitors, pulse oximetry, and capnography might be used to assess the effectiveness of breathing and oxygenation.

Note: Immediate recognition of agonal breathing is crucial as it typically signifies a life-threatening condition requiring urgent medical attention.

Treatment for Agonal Breathing

Treatment for agonal breathing focuses on addressing the underlying cause and providing immediate life support.

Here are the critical steps typically involved:

  • Call for Help: Immediately dial emergency services to get professional help as soon as possible.
  • Cardiopulmonary Resuscitation (CPR): If the person is unresponsive and not breathing normally, begin CPR immediately. This helps maintain vital blood flow to the brain and heart until advanced care arrives.
  • Automated External Defibrillator (AED): Use an AED if available. This device can provide a necessary electric shock to help the heart re-establish an effective rhythm in cases of cardiac arrest.
  • Secure the Airway: In a medical setting, professionals might secure the airway using advanced techniques to ensure open and clear air passage.
  • Oxygen Therapy: Providing supplemental oxygen, if available, to increase oxygenation.
  • Rapid Transport to Hospital: Quick transportation to a hospital is critical for advanced life support and to treat the underlying cause of the agonal breathing.

Note: Agonal breathing is a critical respiratory pattern; therefore, immediate action can be life-saving when dealing with this condition.

Agonal Breathing vs. Gasping

Agonal breathing and gasping are closely related but have specific distinctions that are important in a medical context:

  • Definition: Agonal breathing refers to a pattern of breathing characterized by irregular, labored breaths that are often a sign of severe brain hypoxia or cardiac arrest. It is an involuntary reflex caused by the brain’s response to low oxygen levels. Gasping can be a normal response to sudden stress or fright and involves a single or a few quick, deep breaths. It can also occur as part of agonal breathing but is less specific to severe medical conditions.
  • Frequency and Rhythm: Agonal breathing typically features irregular, sporadic breathing with long pauses between breaths. The rhythm is generally not consistent. Gasping usually occurs in brief episodes, often as a single, sharp intake of breath, without the sustained irregular pattern seen in agonal breathing.
  • Associated Conditions: Agonal breathing is most commonly associated with life-threatening conditions like cardiac arrest, severe brain injury, or respiratory failure. While gasping can be a part of agonal breathing, gasping alone can occur in less critical situations, such as after a scare, during intense pain, or when very surprised.
  • Clinical Importance: Agonal breathing is a critical medical sign that requires immediate intervention, often indicating a need for CPR or other emergency measures. Gasping is typically not a medical emergency unless it persists or is part of an agonal breathing pattern during a severe health episode.

Note: Understanding the context and characteristics of breathing changes like these can help determine the urgency and type of response needed.

What is the Death Rattle?

The “death rattle” refers to a specific sound that can occur when a person is near death and is no longer able to swallow or clear saliva and mucus from the throat or respiratory tract.

Here’s a closer look at its characteristics:

  • Sound: The death rattle produces a gurgling or rattling noise during breathing when air passes through the accumulated secretions in the throat and airways.
  • Cause: It’s typically caused by a weakening of the throat muscles and a decrease in the reflexes necessary to swallow, which are common in the dying process.
  • Indication: While distressing to hear, the death rattle itself isn’t usually a sign of pain or discomfort for the individual experiencing it. It often indicates that death is very near, usually within hours or days.
  • Management: Treatment may focus on the comfort of both the patient and their loved ones. Options include repositioning the patient to help drain secretions, using medications to reduce the production of secretions, or gentle suctioning if appropriate.

Note: The presence of a death rattle is a profound moment in the care of a dying patient, emphasizing the importance of compassionate care and support for the individual and their family.

FAQs About Agonal Breathing

What Does Agonal Breathing Sound Like?

Agonal breathing is typically characterized by irregular, gasping sounds that can be quite noisy. These breaths are often described as labored and may be accompanied by snorting, gurgling, or moaning noises.

The sound is distinctive due to its deep, jagged gasps, which are not rhythmic or steady.

Is a Person Aware During Agonal Breathing?

In most cases, a person is not aware during agonal breathing. This condition generally occurs during severe medical episodes such as cardiac arrest, where the individual is likely to be unconscious or have significantly diminished consciousness. Therefore, awareness during agonal breathing is highly unlikely.

How Loud is Agonal Breathing?

Agonal breathing can vary in volume but is often quite noticeable. It can be loud enough to be heard from a distance, particularly in a quiet room.

The gasping breaths can be abruptly loud and are typically louder than normal breathing, but the overall loudness can depend on the individual and the specific circumstances.

Does Agonal Breathing Sound Like Snoring?

Agonal breathing can sometimes be mistaken for snoring due to its noisy, irregular nature. However, agonal breathing is typically more irregular and labored than snoring.

The sound is often described as a gasping, gurgling, or choking noise, which is more dramatic and distressing than the rhythmic noise of snoring.

Is the Heart Still Beating During Agonal Breathing?

Yes, the heart is usually still beating during agonal breathing, but its functionality may be significantly compromised.

Agonal breathing often occurs in situations like cardiac arrest, where the heart may still have electrical activity and beat ineffectively, failing to circulate blood properly. This results in poor oxygen supply, leading to the characteristic gasping breaths.

What is Agonal Breathing a Symptom of?

Agonal breathing is a symptom of severe physiological distress, most commonly associated with conditions that drastically reduce oxygen supply to the brain.

This can include cardiac arrest, severe heart failure, stroke, major trauma, and overdose, among others. It is a critical sign indicating that immediate medical intervention is necessary.

Is Agonal Breathing Painful?

Agonal breathing itself is not typically associated with pain. It usually occurs in situations where the person is unconscious or has significantly reduced consciousness, such as during cardiac arrest or severe brain injury.

Therefore, the individual is generally not aware of the distressing symptoms, including any pain that might otherwise be felt under different circumstances.

Is Agonal Breathing Fast or Slow?

Agonal breathing is generally slow and highly irregular. It consists of sporadic gasps that are not rhythmic and are often interspersed with long pauses.

This type of breathing is inefficient and does not effectively ventilate the lungs or oxygenate the blood, reflecting its nature as a critical and emergency physiological response.

Is Agonal Breathing the Same as Cheyne-Stokes Breathing?

No, agonal breathing is not the same as Cheyne-Stokes breathing. Agonal breathing involves irregular, gasping breaths that are a sign of severe brain hypoxia and often precede death.

Cheyne-Stokes breathing, on the other hand, is characterized by a cyclical pattern where breathing gradually increases and then decreases in rate and depth, followed by periods of apnea.

Cheyne-Stokes breathing is commonly seen in conditions like congestive heart failure, stroke, or brain injuries, and it indicates different underlying physiological disturbances.

Does Agonal Breathing Always Happen?

No, agonal breathing does not always occur in cases of severe physiological distress or before death. Its presence depends on the specific circumstances and the underlying cause of the medical emergency.

While it is commonly associated with conditions like cardiac arrest, not all individuals experiencing such emergencies will exhibit agonal breathing.

Can You Have Agonal Breathing Without a Pulse?

Yes, agonal breathing can occur without a pulse, particularly in cases of cardiac arrest. During cardiac arrest, the heart may stop beating effectively, or there may be no heartbeat at all, yet agonal breathing might still occur.

This is because agonal breathing is a reflexive effort by the body to obtain oxygen, driven by the brainstem, even in the absence of effective blood circulation.

How Long Can Agonal Breathing Last Before Death?

The duration of agonal breathing can vary widely depending on the individual and the specific medical situation. It may last from a few seconds to several hours.

Agonal breathing is an indication of severe brain hypoxia and is often a precursor to death if immediate and effective medical intervention is not administered.

The exact duration is unpredictable and can be influenced by the underlying health condition and the timeliness of medical response.

Final Thoughts

Recognizing agonal breathing is essential in emergency medical situations, as it often signals severe underlying health issues requiring immediate intervention.

This article has highlighted the significance of identifying the signs and symptoms of agonal breathing, the potential causes, and the crucial steps to take in response.

Understanding these aspects can empower both healthcare providers and bystanders to act effectively, potentially saving lives by ensuring timely medical attention.

John Landry, BS, RRT

Written by:

John Landry, BS, RRT

John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.


  • Perkin RM, Resnik DB. The agony of agonal respiration: is the last gasp necessary? J Med Ethics. 2002.
  • Lokker ME, van Zuylen L, van der Rijt CC, van der Heide A. Prevalence, impact, and treatment of death rattle: a systematic review. J Pain Symptom Manage. 2014.

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