From the Guidelines
Agonal breathing is a life-threatening condition characterized by slow, irregular, and shallow breaths, often accompanied by gasping, snorting, or moaning sounds, and requires immediate intervention with CPR. This condition is typically seen in individuals who are near death or experiencing severe oxygen deprivation, and it is essential to recognize it promptly to initiate life-saving measures. According to the most recent and highest quality study 1, agonal breathing is a critical emergency sign that indicates cardiac arrest or severe hypoxia, and its recognition is crucial to prevent delays in resuscitation efforts. The study highlights that the identification of abnormal breathing or agonal gasps is particularly important in the recognition of cardiac arrest by emergency dispatchers, and that training of emergency dispatchers in the recognition of agonal gasps has been associated with increased dispatcher-guided CPR. Some key characteristics of agonal breathing include:
- Slow and irregular breathing pattern
- Shallow breaths
- Gasping, snorting, or moaning sounds
- Typically seen in individuals who are near death or experiencing severe oxygen deprivation
- Requires immediate intervention with CPR It is essential to note that agonal breathing is not effective breathing, but rather the body's last-ditch effort to get oxygen as the brain stem continues functioning while higher brain centers fail. Despite its name suggesting "agony," the person is typically unconscious and not experiencing pain. If you witness someone with agonal breathing, you should immediately call emergency services (911) and begin CPR, as this breathing pattern indicates the person is in cardiac arrest and requires immediate life-saving intervention. The American Heart Association guidelines 1 emphasize the importance of recognizing agonal breathing and initiating prompt CPR to improve survival rates from out-of-hospital cardiac arrest. In addition, the guidelines highlight the need for emergency dispatchers to be trained in recognizing agonal gasps and other abnormal breathing patterns to facilitate early recognition of cardiac arrest and initiation of CPR. Overall, agonal breathing is a medical emergency that requires immediate attention and intervention with CPR to improve survival rates and outcomes.
From the Research
Definition of Agonal Breathing
Agonal breathing refers to the abnormal breathing patterns that occur in individuals who are near death or experiencing severe respiratory distress.
Characteristics of Agonal Breathing
- It is often characterized by slow, labored, and irregular breaths
- May be accompanied by other signs of respiratory distress, such as gasping or gurgling sounds
- Can be caused by a variety of factors, including opioid overdose, brain injury, or severe lung disease
Relationship to Opioid Use
- Opioids, such as morphine and fentanyl, can cause respiratory depression, which can lead to agonal breathing 2, 3
- The study by 3 found that fentanyl resulted in transient airflow obstructions during the inspiratory cycle, which were absent following morphine administration
- Another study by 2 discussed the changes in brain oxygen levels induced by several opioid drugs, including heroin, fentanyl, oxycodone, and morphine
Key Findings
- A study published in The Journal of Physiology found that both morphine and fentanyl significantly suppressed respiratory frequency, but the onset of suppression was faster with fentanyl 3
- The same study found that fentanyl administration resulted in transient obstructions during the inspiratory phase, suggesting its unique impact on airway stability 3
- A narrative review published in BMJ Supportive & Palliative Care discussed the evidence defining current opioids for breathlessness best practice and identified remaining research gaps 4
Opioid-Induced Respiratory Depression
- Opioid-induced respiratory depression (OIRD) can lead to agonal breathing and even death if left untreated 2, 3
- The study by 3 found that fentanyl-treated mice showed a significantly reduced ability to survive under hypoxic conditions compared to those administered morphine
- Another study by 2 discussed the dangers of opioid-induced respiratory depression and brain hypoxia, which can result in lethality.