agonal breathing
September 12, 2022 BLS

Agonal breathing is a final attempt by the body to survive imminent death. It is a type of final frenzied gasping for air that can be observed in someone who is dying or has recently died. Agonal breathing has also been called death rattle or terminal breath, and it can be a frightening experience for those witnessing it.

This phenomenon typically occurs when an individual’s oxygen supply is depleted and their blood begins to fail to carry adequate amounts of oxygen to their vital organs. The lack of oxygen in the body triggers an emergency response by the person’s central nervous system. To try and restore balance to the body, this response triggers an instinctive gasp for air from the dying person.

If you have ever observed anyone close to death during this final moment, you will know how terrifying it can be because they make eerie gurgling noises as they struggle for their last few breaths on earth. Let’s take a look at the facts about agonal breathing and what you should do if you witness it in someone else.

What is agonal breathing?

Agonal breathing is a type of breathing that occurs in someone who is dying or has recently died. As death is imminent and breathing has begun to slow down, you may hear gurgling sounds in the throat or forcefully see the chest heave as the person tries to take in one last breath of air.

Agonal breathing often occurs in the last moments of life, and it can be a frightening experience for those who are with the person who is experiencing it. Agonal breathing is a sign that death is imminent, and it is also associated with certain medical conditions such as heart attack or stroke.

What is the cause of agonal breathing?

As the levels of oxygen in the blood decrease, the body begins to stimulate the muscles used in breathing. This is an automatic response by the nervous system, and it occurs without the person being conscious of it.

Agonal breathing occurs when the body is experiencing a lack of sufficient oxygen. This can be due to several causes, including inadequate breathing, a breathing obstruction, or a problem in the blood flow, such as a buildup of fluid around the lungs due to heart failure.

  • Inadequate breathing: If a person is not breathing enough on their own, the body will automatically try to assist the person by increasing the frequency of the breaths. When the person is close to death and can no longer breathe on their own, the body automatically triggers agonal respirations.
  • Airway obstruction: If a person attempts to breathe but something is obstructing the airway, the body automatically triggers an agonal breathing response.
  • The problem in the blood flow: If the blood flow is insufficient to oxygenate the vital organs, the body automatically triggers an agonal breathing response.
  • Cardiac arrest: During cardiac arrest, the heart stops pumping blood to the brain, which can cause a loss of consciousness within seconds. This loss of blood flow to the brain causes the brain to start shutting down, which is why agonal breathing often starts during cardiac arrest.
  • Hemorrhagic stroke: Hemorrhagic stroke is a type of stroke caused by bleeding within or around the brain. It occurs due to ruptured blood vessels and arterial inflammation. When a person suffers a hemorrhagic stroke, their breathing can become labored characterized by guppy breathing.

This is because the blood vessels in the lungs are damaged by the stroke, which causes clots to build up inside them. These clots can cause the lungs to collapse, making it difficult for oxygen to reach the person’s bloodstream.

  • Drug overdose: Overdose is a common cause of agonal breathing, especially when the overdose is caused by opioids. The main reason why opioid overdose leads to agonal breathing is that opioids depress the central nervous system (CNS), which leads to reduced respiration.

Oxygen deprivation caused by reduced respiration may lead to coma and eventually death. People suffering from opioid overdose who present with rapid heart rate and high blood pressure will also exhibit very shallow and irregular breathing patterns.

  • Anoxia: Anoxia is caused by a lack of oxygen in the cells and tissues in the body, including the brain. When blood flow to the brain is reduced, it cannot get enough oxygen to function properly. As a result, the body begins to shut down, including vital functions such as breathing and heartbeat. If the anoxia lasts long enough, the person may slip into a coma, stop breathing altogether, and die.

How to recognize agonal breathing: symptoms of agonal breathing

  • Gurgling sounds in the throat: Because the throat becomes swollen during agonal breathing, there is a gurgling sound that can be heard. This occurs from the fluids building up in the throat, which makes it sound like someone is gargling water.
  • Movement in the chest: You might notice that the person’s chest is heaving, which is a sign that the person is trying for one last breath of air.
  • Twitching muscles: As the body is being starved of oxygen, the muscles twitch uncontrollably. You may notice that the person’s eyelids, hands, legs, and feet all twitch as the oxygen are being depleted from the brain, which leads to a near-comatose state.
  • Unconsciousness: The person may also become unresponsive, which can be a sign that their brain is now being starved of oxygen.
  • Slurred speech: Speech becomes slurred when a person is in the process of dying. The breathing process becomes shallow and irregular causing the tongue to move slowly. Slurred speech is a sign of agonal breathing, which is shallow, irregular breathing that occurs during the dying process. The respiratory system is one of the first systems to shut down when a person is dying.
  • Numbness: Agonal breathing can cause numbness in the hands and feet because there is not enough oxygen getting to the body to sustain the normal flow of blood to the limbs.

What should you do if you witness someone with agonal breathing?

The first step is to make sure that the person is receiving medical attention. If you are in a hospital setting, let the nurses know as soon as possible. If you are not in a hospital setting, let a family member or friend know that the person is nearby and needs assistance.

If the person is not receiving medical attention, gently place their hands on their chest to assist with breathing. You can also gently shake the person’s shoulders, or tap them on the cheek to try and bring them back to consciousness. If the person is still unresponsive and showing signs of agonal breathing, call 9-1-1 immediately. You should also try and place the person in the recovery position (on their side) if they are still breathing.

Agonal breathing and cardiopulmonary resuscitation (CPR)

As agonal breathing is a sign that death is imminent, it is not recommended that you perform CPR on a person in this state. CPR is a life-saving technique that is used to provide oxygen to the person’s heart and lungs. It involves pressing on the person’s chest and blowing air into the lungs to try and get their blood flowing again.

While CPR can be extremely effective, it is not recommended that you perform CPR on a person who is experiencing agonal breathing. The main reason for this is that the person is likely to be unresponsive. Instead, it is recommended that you call an ambulance and let the professionals take care of the situation.

The difference between agonal breathing and other breathing conditions

  • Pulmonary Embolism: A pulmonary embolism is a blockage of the main pulmonary artery by a blood clot that has traveled from the heart through the bloodstream. Agonal breathing is often mistaken for pulmonary embolism, as both conditions involve difficulty breathing, but they are very different. Agonal breathing is a sign of impending death in a person with a terminal illness, while pulmonary embolism is a serious medical emergency that requires immediate treatment.
  • COPD: COPD is a chronic disease that affects the lungs. It can make breathing difficult and lead to shortness of breath, wheezing, and coughing. COPD is a common cause of agonal breathing because it can cause respiratory failure, which results in shallow and dyspnea which is the medical term for shortness of breath. However, it is important to note that agonal breathing can occur in people who do not have COPD.
  • Death rattle: What does the death rattle sound like? A death rattle is a rattling sound that occurs when saliva and mucus pool in the throat, making it difficult to breathe. When a person is close to death, the muscles of the throat relax, which can cause the soft tissues in the back of the mouth to vibrate.

Death rattle usually occurs when a person is only hours or days away from death, whereas agonal breathing can begin even weeks before death. Has anyone survived the death rattle? Yes, though most of these cases involved people who were in the process of dying, then got better and were able to recover. This was sometimes because they were able to get medical treatment, but it could also have been because their conditions changed in some way.

  • Lung cancer: Lung cancer is a rare form of cancer that affects the lungs. It is usually found in the later stages of the disease but can be detected before any symptoms are present. Agonal breathing is often confused with lung cancer, as they can both cause shortness of breath. However, agonal breathing is caused by organ failure, while lung cancer is caused by abnormal cells growing in the lungs.

Is there any way to stop or reduce agonal breathing?

Because agonal breathing is an automatic response by the nervous system, there is very little that you can do to stop it. However, there are certain things that you can do to relieve some of the symptoms. If the person is experiencing gurgling sounds in their throat, you can try and clear it with the Heimlich maneuver. You can also try and position the person in a way that will help with the breathing, such as placing them on their side.

Deep breathing can also help to take in more oxygen, which can help reduce agonal breathing and also help relax the body. Another way is to keep calm and stay as still as possible. If you can stay calm, your body will not have as much of a need to breathe quickly and shallowly.

Agonal breathing and death

Agonal breathing is often a sign that death is imminent. Because of this, it is often associated with other medical conditions that are life-threatening. If you witness a loved one experiencing agonal breathing, it is important to remain calm and seek medical attention as soon as possible.

If you are in a hospital setting, let the nurses know as soon as possible that you have witnessed agonal breathing. If you are not in a hospital setting, let a family member or friend know that the person is nearby and needs assistance. If you know someone who is terminally ill, it is important to discuss their wishes regarding life-prolonging treatment, such as CPR.

Wrapping up

If you have witnessed agonal breathing in a loved one, it is important to remain calm and keep them comfortable. This can be difficult, but it is important to remember that you cannot change what is happening. You can try to reduce the symptoms of agonal breathing by placing the person on their side, gently rubbing their back, or clearing their throat if necessary. You can also try to calm any other people who are present. Most importantly, you should make sure that the person is receiving medical attention as soon as possible.

If you’d like to learn more about CPR, First Aid, BLS, BBP, or healthcare CPR and when it is the correct time to give CPR, get in touch with the National CPR Foundation today.

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