What is agonal breathing? Agonal breathing is a medical term that refers to a respiratory effort demonstrating an ineffective and labored gasping for air. Agonal breathing is not true breathing, resulting in the patient being deprived of oxygen. What is happening in the body that results in this ineffective ventilatory effort is the biggest concern. The brain stem controls the breathing reflex when the rest of the brain lacks awareness. Since the brain stem handles vital functions in dire situations, this type of abnormal ventilatory effort is usually a sign that the patient is in critical need of emergency intervention and death is imminent.
Agonal breathing may present during a severe medical crises like a stroke or a cardiac arrest. Once the heart stops pumping blood, or oxygenated blood can’t reach the brain stem, seconds become critical. Unless oxygenated blood is allowed to reach the brain, permanent brain damage and then death rapidly occur. Observers of this abnormal breathing pattern may assume that the heart is still operating sufficiently, and the brain is oxygenated since the patient manifests a breathing pattern.
Unfortunately, that misconception often leads to observers not taking critical action in a time of emergency. After the onset of agonal respirations, mere minutes remain before brain death occurs with the absence of intervention. Recognizing this ineffective gasp is essential when someone is experiencing a severe medical emergency. Administering CPR proves particularly crucial, affording precious additional minutes, while experience healthcare professionals arrive on the scene to administer more complex and effective treatments.
What Are the Signs and Symptoms of Agonal Breathing?
Here are the signs and symptoms to help you recognize agonal breaths:
- Gasping for air – The person’s breathing seems fast and short. Inhalation is often a gasp, and not of sufficient depth to have new oxygenated air pass the dead space of the airway, and enter into the lungs for the blood to be oxygenated.
- Labored breathing – Breathing looks difficult and strained.
- Strange vocal sounds – Sometimes the person makes odd breathing noises, like snorting, moaning, or gurgling noise while they gasp. These can occur during both inhalation and exhalation.
- Myoclonus – This means sudden muscle jerks that are not on purpose. Muscles move on their own without the person making the movements intentionally.
- Irregular breathing – The pattern of respiration doesn’t follow a regular rhythm and depth. Each breath can seem different from the next one.
- Abnormal respiration – The person’s respirations do not flow in and out in a continuous regular pattern.
- Loss of consciousness – The person may lose consciousness.
If you witness someone manifesting these signs, we should make it clear, it means they are in immediate need of emergency medical attention.
Differences Between Agonal Breathing Versus Other Breathing Conditions
Understanding the nuances between different types of breathing, such as the death rattle, is crucial for healthcare providers. This insight aids in accurate diagnosis and timely intervention.
| Breathing Condition | Description | Key Differences from Agonal Breathing (AB) |
|---|---|---|
| Death Rattle | This occurs due to secretions in the throat or airways. | This should be treated with anti-cholinergic medications, unlike agonal breathing which requires immediate CPR. |
| Kussmaul Breathing | This is rapid, deep breaths caused by metabolic acidosis. | This is characterized by a consistent deep and rapid pattern, unlike the erratic and intermittent gasps of AB. |
| Cheyne-Stokes Respirations | This is a pattern of breathing with periods of apnea. | This features cyclical increases and decreases in ventilatory depth followed by pauses, while AB is comprised of erratic respirations without a predictable pattern. |
| Ataxic Respirations | Known as Biot’s respirations, this breathing pattern is nonuniform with periods of apnea. | Though both exhibit nonuniform patterns, ataxic respirations do not have the characteristic gasping sound of AB. |
These comparisons showcase the importance of recognizing agonal breathing within the context of emergency response. Proper identification leads to appropriate action, potentially saving lives.
What Can Cause Agonal Breathing? Common Causes and Triggers
Agonal breathing is often started by heart, circulatory, or ventilatory issues. It is a symptom when a person’s brain is not getting enough oxygen.
The occurrence of a cardiac arrest is one of the most common causes of agonal breathing. During a sudden cardiac arrest the heart has stopped oxygenated blood flow to the brain stem, leading to a rapid deterioration of it’s vital functions, including regular effective breaths. Some chronic diseases can increase the likelihood of an out-of-hospital cardiac arrest, such as chronic obstructive pulmonary disease (COPD) or an chronic arrhythmia affecting the heart’s electrical system.
Ischemic stroke is another medical emergency that can result in agonal breathing. If a blood clot deprives the brain stem of oxygenated blood, cerebral ischemia occurs and the brainstem quickly dies from hypoxia.
Hemorrhagic stroke is another circulator issue that can lead to agonal respirations. If there is a hemorrhage that prevents blood from reaching the brain stem, oxygenation is often impeded which can affect ventilatory function.
Sometimes, the brain itself is damaged through external trauma that can lead to disfunction, resulting in this type of agonal respirations.
Drowning and choking are also culprits. If insufficient oxygenated air can enter the lungs then there will be a cascade of events, including cardiac arrest, resulting in the loss of oxygenation to the brain stem.
Drug overdose is another common cause of this event. Some recreational drugs reduce the body’s drive to breathe, which can lead to a hypoxic brain injury, resulting in agonal respirations.
When severe cardiopulmonary emergencies occur, such as stroke or cardiac arrest, an observer can expect the lungs, heart, and brain to stop working properly.
How Is Agonal Breathing Treated? Emergency Responses and Treatments
Treating agonal breathing has been studied extensively by academic research institutions. It requires fast and responsive action. If two people observe the emergency it is best to have one person call for help, activating emergency services, while the other starts CPR right away to give the person the best chance of survival.
Do not wait to see if things get better on their own. Seek help.
- Activate Emergency Medical Services (EMS)
Immediately call 911 and ask the dispatcher to send paramedics. Calling EMS is the first key action to take when you encounter someone showing signs of agonal breathing. Since about 40% of cardiac arrests outside of the hospital show this type ventilatory event, it should always be considered a sign of serious emergent distress.
EMS teams bring critical care to the person in need. They can do lifesaving measures like CPR, AED application, and the administration of emergency medications. This fast response can make a huge difference in the survival of the patient. The paramedics will also provide medical assistance over the phone, guiding the caller through the steps of CPR and first aid until help arrives.
2. Immediate CPR and Potential Advanced Intervention is the second key step for managing agonal breathing. These steps can save lives when someone is in distress.
- Perform CPR immediately to keep blood flowing. Begin by performing chest compressions, pushing hard and fast in the center of the chest, and providing rescue breaths by mouth-to-mouth.
- Use an Automated External Defibrillator (AED) performing defibrillation, if advised, before the ambulance arrives.
- Keep doing CPR in hopes to be able to preserve sufficient circulatory function until help comes or the patient starts to demonstrate normal breathing, and potentially a normal heart rhythm.
3. Arrival of EMS
- EMS may perform additional Basic Life Support (BLS) related interventions. These include airway management and oxygen therapy.
- After initial CPR, Advanced Cardiac Life Support (ACLS) may also be necessary. This involves more detailed care like advanced airway placement, mechanical ventilation, and drug therapy.
- Lifesaving techniques also focus on treating the underlying condition, such as a patient’s heart rhythm, airway obstruction, or cardiac arrest.
Each step is a link in a chain that gives someone the best chance at survival until they can get professional medical intervention.
Conclusion
Agonal breathing is a serious sign that a person’s life is in eminent danger. It requires a quick response for optimal patient outcomes. It shows up as gasping with ineffective and abnormal breathing. People see it mostly in severe emergencies like cardiac arrest. The key is calling for professional emergency help followed my immediately starting CPR. Additional medical interventions may be needed. Through these interventions, a life can be saved by getting oxygen to the brain quickly.
