Agonal breathing is the slow, gasping pattern of breaths that can appear in someone who has gone into cardiac arrest. It happens because the heart has stopped pumping blood, and the brain stem reflexively tries to draw air. The chest moves, but no oxygen reaches the body. People often mistake it for breathing, which is why so many cardiac arrest victims do not receive CPR in time. If you see someone unresponsive and gasping like this, call 999 and start chest compressions straight away.
What agonal breathing looks like:
- Slow, infrequent gasps, often only two or three per minute
- Snoring, gurgling, or moaning sounds
- The chest may move briefly with each gasp, then stops between gasps
- Eyes may be open, glazed, or rolled back
- The person does not respond when being shaken or shouted at
What is Agonal Breathing?
Agonal breathing refers to irregular, gasping breaths that happen during cardiac arrest. It is the body’s automatic reflex as the heart stops pumping adequate blood to the brain and vital organs.
These sporadic gasps may persist for several minutes after someone loses consciousness. Agonal breaths sound like snorting, gurgling, or moaning noises. The chest may appear to rise and fall.
Agonal breathing should not be confused with normal breathing.
It does not represent adequate oxygen intake. Agonal respiration indicates a dire emergency requiring immediate medical intervention.
Key Signs of Agonal Breathing
Watch for these symptoms of agonal breathing in someone who is unresponsive:
- Sporadic, infrequent gasping breaths
- Abnormal snoring or gurgling sounds
- Slow, irregular chest movements
- Blue skin colour (cyanosis) due to oxygen deprivation
- No pulse palpated
- Dilated pupils unreactive to light
Compare agonal breathing to the normal respiratory rate of 12-20 breaths per minute in adults. Agonal gasps occur only 2-3 times per minute or slower. The breathing pattern is markedly abnormal.
Agonal Breathing as a Sign of Cardiac Arrest
Agonal respiration most commonly occurs during sudden cardiac arrest. When the heart stops pumping blood effectively, delivery of oxygen to the brain is compromised.
The agonal gasps represent the brain stem’s instinctive but ineffective attempt to recommence breathing. Without prompt defibrillation and CPR, respiratory arrest follows.
Agonal breathing can also arise from:
- Drowning
- Stroke
- Drug overdose
- Asphyxiation
- Exsanguination (severe bleeding)
Any medical emergency impairing oxygenation of the brain can trigger agonal breathing before complete respiratory failure.
Responding to Agonal Breathing
Recognising agonal respiration allows bystanders to initiate potentially lifesaving interventions for cardiac arrest.
Follow these steps if you see agonal breathing:
- Check for consciousness. Shake the shoulder and shout.
- If no response, call emergency services immediately.
- Begin chest compressions. Push hard and fast in the centre of the chest.
- Follow dispatcher instructions. They may advise you to retrieve and use an AED.
- Continue CPR until paramedics arrive.
Even with agonal gasps, do not assume the person is getting adequate oxygen. Start CPR immediately and use an automated external defibrillator (AED) as soon as possible to restore a perfusing heart rhythm.
Early bystander intervention can dramatically improve survival odds in cardiac arrest. Acting quickly when you spot agonal breathing gives the victim the best chance of recovery with minimal neurological consequences.
Improving Recognition of Agonal Breathing
Bystander response is hindered when people mistake agonal respiration for normal breathing. Education is key to improving recognition and response.
You can help save lives by learning the signs of agonal breathing and sharing them with others. Taking CPR/AED certification courses also prepares you to take action in an emergency.
Fast action can save more lives from sudden cardiac arrest through proper identification and response to agonal breathing. Stay alert to this critical warning sign and be ready to perform lifesaving interventions while awaiting paramedic arrival.
Agonal Breathing Simulation
The video below showcases an actor simulating a cardiac arrest and agonal breathing.
Frequently Asked Questions
Common questions about agonal breathing, answered clearly and directly.
What does agonal breathing sound like?
Agonal breathing usually sounds like loud snoring, gurgling, choking, or moaning. Some people describe it as a wet rasping noise or a low groan. It is not the soft, regular sound of normal breathing, and it comes in slow gasps rather than a steady rhythm.
Witnesses often describe being startled by how loud the sound is. It can be loud enough to wake someone in another room, which is sometimes how a cardiac arrest at home is first noticed. Despite how dramatic the sound is, the person making it is unresponsive and not breathing properly.
Category: Cardiac ArrestHow long does agonal breathing last?
Agonal breathing usually lasts a few minutes after someone goes into cardiac arrest. Some people stop gasping within thirty seconds, while others continue for several minutes. Once the gasps stop, the person has gone into full respiratory arrest. CPR should already be underway by that point.
The length of time agonal breathing continues is not a useful measure of how long someone has left. The brain begins to suffer damage from lack of oxygen within four to six minutes of cardiac arrest. Survival drops sharply with every minute that passes without chest compressions and a defibrillator. Do not wait for the gasping to stop. Start CPR as soon as you recognise it.
Category: Agonal BreathingIs agonal breathing a sign of life?
No. Agonal breathing is a brain stem reflex, not real breathing. The person is unresponsive, the heart is not circulating blood, and oxygen is not reaching the body. Without immediate CPR and defibrillation, they will die.
This is one of the most dangerous misunderstandings in bystander response to cardiac arrest. Because the chest still moves and there is still some sound of breathing, witnesses often assume the person is breathing normally. They wait for paramedics instead of starting CPR. By the time help arrives, the chance of survival has often gone.
If someone is unresponsive and you see agonal breathing, treat it as cardiac arrest. Call 999 and start chest compressions. You cannot make things worse, but you can save a life.
Category: Cardiac ArrestShould I start CPR if someone is gasping?
Yes. If someone has collapsed, is unresponsive, and is gasping or breathing abnormally, treat it as cardiac arrest. Call 999 and start chest compressions straight away. The 999 dispatcher will guide you through what to do. Do not wait to see whether the gasping stops first. Every minute without CPR cuts the chance of survival.
Gasping during cardiac arrest is called agonal breathing, and it is not effective breathing. The person is not getting any oxygen. Bystander hesitation is one of the biggest factors in poor cardiac arrest outcomes in the UK. A common reason for hesitation is uncertainty about whether the person is really not breathing.
If you are unsure, start CPR. The Resuscitation Council UK and every major guideline are clear: if someone is unresponsive and not breathing normally, begin chest compressions. You will not harm a person who turns out to be alive, and you may save the life of someone in cardiac arrest.
Category: Cardiac ArrestWhat’s the difference between agonal breathing and normal breathing?
Normal breathing is steady, quiet, and happens twelve to twenty times per minute in adults. Agonal breathing is irregular, loud, and happens only two or three times per minute, sometimes less. Normal breathing delivers oxygen to the blood. Agonal gasping does not. Anyone showing agonal breathing while unresponsive is in cardiac arrest and needs CPR.
The simplest way to tell the difference is to look at the whole picture. A person breathing normally will be responsive, with a regular chest rise and fall and quiet airflow. A person with agonal breathing will be unresponsive, with infrequent gasps and often a snoring or gurgling sound. The chest may move briefly between gasps before stopping altogether.
If you cannot tell whether breathing is normal, treat it as not normal. The cost of starting CPR on someone who turns out to be fine is minor. The cost of not starting CPR on someone in cardiac arrest is fatal.
Category: Cardiac Arrest