From the Guidelines
Agonal breathing is caused by severe oxygen deprivation to the brain during cardiac arrest or other life-threatening conditions, resulting in irregular, gasping breaths that are ineffective for proper oxygenation. This condition occurs when the brain stem, which controls basic life functions, continues to send signals to the respiratory muscles despite the heart no longer effectively pumping blood 1. According to a study published in Circulation in 2012, agonal gasps represent a brain stem response to ischemia and can persist for several minutes, making it challenging for bystanders and dispatchers to recognize cardiac arrest 1.
Key Characteristics of Agonal Breathing
- Irregular, gasping breaths
- Ineffective for proper oxygenation
- Commonly seen in the final moments before death or during cardiac arrest
- Can occur during severe brain injury, drug overdose, or drowning
Recognizing agonal breathing is critical because it indicates a medical emergency requiring immediate CPR and calling emergency services 1. A study published in Circulation in 2015 reported that agonal breaths were present in approximately 30% of cases, which can make obtaining an accurate description of the patient’s breathing pattern challenging for dispatchers 1. Understanding that agonal breathing represents impending cardiopulmonary failure rather than normal respiration can help bystanders recognize the need for immediate life-saving interventions.
Importance of Recognition
- Indicates a medical emergency requiring immediate CPR and calling emergency services
- Can be challenging to recognize due to irregular breathing patterns
- Requires immediate attention to prevent further deterioration of the patient's condition
In real-life clinical practice, it is essential to prioritize the recognition of agonal breathing and provide immediate interventions to improve patient outcomes 1. By understanding the characteristics and importance of agonal breathing, healthcare professionals and bystanders can take prompt action to save lives.
From the Research
Causes of Agonal Breathing
- Agonal breathing is caused by the preservation of brainstem function, specifically the lower brainstem neurons, during cardiac arrest 2.
- As higher centers become increasingly hypoxic during cardiac arrest, agonal respirations originate from these lower brainstem neurons 2.
- Agonal breathing is a relatively common symptom that follows cardiac arrest when the brainstem function is preserved 3.
Physiological Understanding
- Animal studies demonstrate that agonal respirations can produce clinically important ventilation, oxygenation, and circulation 2.
- In human studies, agonal respirations are apparent in 40% of persons suffering out-of-hospital cardiac arrest 2.
- Agonal respirations are associated with witnessed events, ventricular fibrillation, and survival, suggesting that agonal respirations are a marker of an arrest's early phase and may potentially directly affect cardiopulmonary function 2.
Clinical Implications
- Agonal respirations pose the greatest challenge to bystanders at the scene and to emergency dispatchers, as they may be mistaken for normal breathing 4.
- Agonal respirations may inhibit rescue efforts by preventing arrest recognition, as bystanders may be lulled into thinking the person is still breathing 4.
- A standardized dispatch approach can help dispatchers identify agonal respirations by distinguishing normal and abnormal breathing in the unconscious patient 2.