Agonal respiration

Agonal respirations
Cardiopulmonary resuscitation in progress
Treatment	Cardiopulmonary Resuscitation

Agonal respiration, gasping respiration, or agonal breathing is a distinct and abnormal pattern of breathing and brainstem reflex characterized by gasping, labored breathing, and is accompanied by strange vocalizations and myoclonus. Possible causes include cerebral ischemia, hypoxia (inadequate oxygen supply to tissue), or anoxia (total depletion of oxygen). Agonal breathing is an extremely serious medical sign requiring immediate medical attention, as the condition generally progresses to complete apnea and heralds death. The duration of agonal respiration can range from two breaths up to several hours of labored breathing.^[1]

The term is sometimes, inaccurately, used to refer to labored, gasping breathing patterns accompanying organ failure (e.g., liver failure and kidney failure), SIRS, septic shock, and metabolic acidosis (see Kussmaul breathing, Cheyne Stokes respirations, or in general any labored breathing, including ataxic respirations). Notably, end of life inability to tolerate secretions, known as the death rattle, is a separate phenomenon^[2][3].

Agonal respirations are also commonly seen in cases of cardiogenic shock (decreased organ perfusion due to heart failure) or cardiac arrest (failure of heartbeat), where agonal respirations may persist for several minutes after cessation of heartbeat.^[1][4][5] The presence of agonal respirations in these cases indicates a more favorable prognosis than in cases of cardiac arrest without agonal respirations. In an unresponsive, pulseless patient in cardiac arrest, agonal respirations are not effective breaths and are signs of cardiovascular and respiratory system failure. Agonal respiration occurs in 40% of cardiac arrests experienced outside a hospital environment.^[5]