Agonal respiration

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Not to be confused with Agonal heart rhythm.

Agonal respiration, gasping respiration or agonal breathing is an abnormal pattern of breathing and brainstem reflex characterized by gasping, labored breathing, accompanied by strange vocalizations and myoclonus.[1]:164, 166 Possible causes include cerebral ischemia, extreme hypoxia or even anoxia. 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 be as brief as two breaths or last up to several hours.[1]

The term is sometimes (inaccurately) used to refer to labored, gasping breathing patterns accompanying organ failure (e.g. liver failure and renal failure), SIRS, septic shock, and metabolic acidosis (see Kussmaul breathing, or in general any labored breathing, including Biot's respirations and ataxic respirations). Correct usage would restrict the term to the last breaths before death.[citation needed]

Agonal respirations are also commonly seen in cases of cardiogenic shock or cardiac arrest where agonal respirations may persist for several minutes after cessation of heartbeat.[1] 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 gasps are not effective breaths. Agonal respiration occurs in 40% of cardiac arrests experienced outside a hospital environment.[2]

Agonal respiration is not the same as, and is unrelated to, the phenomenon of death rattle.


  1. ^ a b c Perkin, RM; Resnik, DB (June 2002). "The agony of agonal respiration: is the last gasp necessary?". Journal of medical ethics 28 (3): 164–9. PMID 12042401. 
  2. ^ Clark, Jill J; Larsen, Mary Pat; Culley, Linda L; Graves, Judith Reid; Eisenberg, Mickey S (December 1992). "Incidence of agonal respirations in sudden cardiac arrest". Annals of Emergency Medicine 21 (12): 1464–1467. doi:10.1016/S0196-0644(05)80062-9. Retrieved 21 February 2015. 

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