Agonal respiration
Gasping breathing pattern indicating brainstem activity near death.
Agonal respiration, also known as gasping respiration or agonal breathing, is a distinct and abnormal pattern of breathing and brainstem reflex characterized by gasping, labored breathing, strange vocalizations, and myoclonus. It is a severe medical sign that generally progresses to complete apnea and preludes death, requiring immediate medical attention.
- field
- Medicine
- known_for
- Abnormal gasping breathing pattern associated with cardiac arrest and imminent death
- related_conditions
- Cerebral ischemia, hypoxia, anoxia, cardiac arrest, cardiogenic shock
- occurrence
- 40% of out-of-hospital cardiac arrests
- duration
- From two breaths to several hours
Lore & Background
Agonal respiration is a brainstem reflex that occurs when the medulla oblongata, the lowest part of the brainstem, remains active despite severe cardiovascular and respiratory compromise. The gasping is speculated to be due to a reflex triggered by low oxygen concentrations in the blood. This breathing is insufficient to sustain life and is commonly seen in cases of cardiogenic shock or cardiac arrest, where it may persist for several minutes after the heartbeat has stopped.
Reader's Guide
Agonal respiration is a critical clinical sign that demands immediate emergency response, including CPR, chest compressions, and activation of emergency medical services. Its presence in out-of-hospital cardiac arrest is associated with better neurological outcomes and higher rates of survival to hospital discharge compared to cardiac arrest without agonal respirations. The term is sometimes inaccurately used for labored breathing in other conditions like organ failure or septic shock, but it is distinct from the death rattle, which involves inability to tolerate secretions. Understanding agonal respiration helps clinicians recognize a potentially salvageable state where brainstem activity persists, guiding resuscitation efforts.
Did You Know?
- Agonal respiration occurs in 40% of cardiac arrests experienced outside a hospital environment.
- Patients with agonal respirations during cardiac arrest are more likely to be discharged home alive than those without.
- The word 'agonal' stems from 'agony,' denoting a struggle, and is used exclusively in medicine for physiologic dynamics just prior to or at death.
- Agonal respirations may persist for several minutes after cessation of heartbeat.
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