What do you do if a person is unresponsive but gasping?

Gasping, or agonal respiration is an indicator of cardiac arrest. When these irregular breathing patterns occur, it’s a sign that the victim’s brain is still alive and that you must begin uninterrupted chest compressions or CPR immediately.

If you do so, the person has a much higher chance of surviving. In fact, bystander-initiated CPR has been proven to be a sudden cardiac arrest (SCA) victim’s best chance of survival. Approximately About 90 percent of people who experience an out-of-hospital cardiac arrest (OHCA) die; however, nearly 45 percent of OHCA victims survived when bystander CPR was administered (American Heart Association).

Often, agonal breathing is seen during cardiac arrest, and in most cases, rescuers report observing these so-called “dying breaths” fewer than 10 to 12 times per minute (as opposed to 12-20 inhalations in typical respiration).

Agonal respiration does not provide adequate oxygen to maintain body functions and should not be considered breathing.

Gasping or agonal respirations commonly occur following or during sudden cardiac arrest or stroke. Based on paramedic reports, researchers found that gasping occurred in 56% of patients who suffered an out-of-hospital cardiac arrest. They also found that gasping or agonal breathing is likely more common soon after cardiac arrest and is most common in individuals who receive bystander CPR (Science Direct).

Symptoms of Agonal Breaths

Agonal breathing can last for minutes or up to several hours. Someone who is suffering from agonal breathing may appear to be gasping for air, snorting, gurgling, or moaning, or they may make grunting sounds or display myoclonus — the sudden, uncontrollable jerking of muscle groups.

“The gasping associated with agonal breathing is not true breathing, but rather a brainstem reflex. Agonal breathing often occurs because the heart is no longer circulating oxygen-rich blood. In other cases, it may be due to the lungs not bringing in enough oxygen” (Medical News Today).

Causes of Agonal Breathing

In most cases, patients that suddenly stop breathing without warning and exhibit agonal breaths are likely suffering from cardiac arrest. However, respiratory arrest brought on by severe asthma, choking, stroke, or an opioid or narcotic overdose may also cause agonal breathing.

How to Treat Agonal Breathing

If someone is exhibiting symptoms of agonal breathing, resuscitation efforts should begin immediately and 911 should be called.

“In cases where the patient is not breathing or has agonal respirations but still has a pulse, he or she is considered to be in respiratory arrest rather than cardiac arrest. The 2015 CPR guidelines call for lay rescuers to treat both conditions the same: by starting CPR” (Very Well Health).

The Value of Gasping During Out-of-Hospital Out-of-Hospital Cardiac Arrest

In 2017 a study published in the Journal of the American College of Cardiology found that gasping during CPR was associated with an increased survival rate. The study noted that “These findings underscore the importance of not terminating resuscitation prematurely in gasping patients and the need to routinely recognize, monitor, and record data on gasping in all future cardiac arrest trials and registries.”

What You Can Do to Help Someone Suffering from Agonal Breathing

Learn CPR. Without CPR, agonal breathing brought on by cardiac arrest is fatal. If you know someone who is at an increased risk for a stroke or cardiac arrest, you’ll need to be able to quickly identify the symptoms and then respond with high-quality CPR.

Gasping for air (agonal breathing) is usually a sign that the heart is no longer circulating oxygenated blood. It’s often a brief and inadequate pattern of breathing.

Overview

Agonal breathing, or agonal respiration, is the medical term for the gasping that people do when they’re struggling to breathe because of cardiac arrest or another serious medical emergency.

The desperate gasping for air is usually a symptom of the heart no longer circulating oxygenated blood, or there’s an interruption of lung activity that’s reducing oxygen intake. It can often signal that death is imminent.

If you see someone struggling to breathe, call your local emergency medical services immediately.

Agonal breathing isn’t the same as a “death rattle.” This is the gurgling noise that some people make when they’re dying. Death rattle is caused by saliva or mucus collecting in the throat or chest. Agonal breathing is instead an abnormal and often brief and inadequate pattern of breathing.

Agonal breathing may sound like gasping, but it can also sound like snorting and labored breathing. It may even seem as though the person is moaning. The abnormal breathing may last only a few breaths or could go on for hours. The cause of agonal breathing will affect how long it goes on and whether there are other symptoms.

Agonal breathing commonly occurs with cardiac arrest or a stroke. It’s possible the person may lose consciousness while gasping. Stroke symptoms include:

  • weakness on one side of the body
  • facial droop
  • lack of coordination
  • poor speech or an inability to understand speech
  • a sudden headache

Agonal breathing can occur when someone has gone into cardiac arrest. Unlike a heart attack — which happens when one or more arteries narrow and stop blood from reaching the heart muscle — cardiac arrest is an electrical problem. During cardiac arrest, the heart stops beating effectively. This is known as an arrhythmia, or pattern of irregular heartbeats.

Blood continues to flow briefly in the brain and other organs, which can cause gasps for a few minutes after the heart stops. If cardiac arrest is the cause of agonal breathing, the labored breaths may only last a few minutes. Having had a heart attack makes it more likely to have cardiac arrest.

Another common cause of agonal breathing is cerebral ischemia, or a reduction in blood flow to the brain. This can be caused by a ministroke due to a blood flow blockage within a brain blood vessel. It can also be caused by a hemorrhagic stroke due to a bleeding blood vessel within the brain. Either can lead to a condition called cerebral hypoxia, which is insufficient oxygen supply to the brain regardless of the cause. The brain can have permanent damage if it’s deprived of oxygen for too long.

Gasping for breath is a sign that something is wrong. Anyone gasping for breath — even if there are no other obvious symptoms — needs emergency medical help.

Call your local emergency services and tell the dispatcher about the person’s abnormal breathing and any other symptoms you’ve noticed. If the dispatcher asks if the person is breathing, don’t simply say yes because you hear gasping and snorting. Make it clear that the breathing isn’t steady.

If you’re not sure why the person is having trouble breathing, ask the dispatcher what you should do and if it’s OK to try CPR.

Agonal breathing and CPR

If you believe that someone is in cardiac arrest and is in the middle of an agonal breathing episode and you know CPR, you should begin chest compressions and do what you can to continue chest compressions until help arrives.

A person in cardiac arrest may also be revived with the help of an automated external defibrillator (AED). There’s no need to perform mouth-to-mouth. This has been shown to interfere with blood flow to the heart muscle.

If cardiac arrest occurs, the person usually drops or slumps to the ground.

Regardless of the cause of agonal breathing, the first response of paramedics or emergency room personnel is to restore a normal heart rhythm and breathing.

If the heart has stopped, a defibrillator may be needed to restart it. Mechanical ventilation may also be necessary to get air into the lungs and restart oxygen flow through the body. Blood pressure may also need to be maintained with medications.

Agonal breathing is often fatal. Brain cells can die if they’re deprived of oxygen for more than five minutes.

If you know how to respond to someone having this breathing difficulty, you may be able to save their life. The most important response is to contact local emergency services. Paramedics may be able to preserve heart and brain health, as well as the health of other organs if they can reach the person in time.

A personal or family history of heart attack, history of heart failure, or an abnormal heart rhythm increases a person’s risk for cardiac arrest. High blood pressure and a family history of strokes make you more vulnerable to stroke.

If you know someone who’s at risk for a stroke or cardiac arrest, know the symptoms of agonal breathing. You should also know how to respond:

  • Always call your local emergency services first. Most ambulances are equipped with the tools, medications, and communication equipment necessary to help keep the person alive.
  • If you’re trained in CPR, provide continuous chest compressions until help arrives.

Agonal breathing is a sign that something is wrong. It should never be ignored.

What is your action if the person is unresponsive and person is gasping?

Sometimes when a person is unresponsive their breathing may become noisy or irregular, or they may be gasping. This is usually a sign that their heart is not working properly and you should start chest compressions.

What would be the next step when you find an unresponsive victim who has agonal gasps?

Agonal breathing is common in the first few minutes after a sudden cardiac arrest (when the heart stops beating). Agonal breathing is sudden, irregular gasps of breath. This shouldn't be mistaken for normal breathing and CPR should be given straight away.