Agonal respiration, gasping respiration or agonal breathing is a distinct abnormal pattern of

breath Breathing (or ventilation) is the process of moving air into and from the lungs to facilitate gas exchange with the internal environment, mostly to flush out carbon dioxide and bring in oxygen. All aerobic creatures need oxygen for cellula ...

ing and

brainstem The brainstem (or brain stem) is the posterior stalk-like part of the brain that connects the cerebrum with the spinal cord. In the human brain the brainstem is composed of the midbrain, the pons, and the medulla oblongata. The midbrain is conti ...

reflex characterized by gasping, labored breathing, accompanied by strange vocalizations and

myoclonus Myoclonus is a brief, involuntary, irregular (lacking rhythm) twitching of a muscle or a group of muscles, different from clonus, which is rhythmic or regular. Myoclonus (myo "muscle", clonic "jerk") describes a medical sign and, generally, is ...

. Possible causes include

cerebral ischemia Brain ischemia is a condition in which there is insufficient bloodflow to the brain to meet metabolic demand. This leads to poor oxygen supply or cerebral hypoxia and thus leads to the death of brain tissue or cerebral infarction/ischemic stroke. ...

, extreme hypoxia (inadequate oxygen supply to tissue), or even 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 Apnea, BrE: apnoea, is the temporal cessation of breathing. During apnea, there is no movement of the muscles of inhalation, and the volume of the lungs initially remains unchanged. Depending on how blocked the airways are ( patency), there may ...

and heralds death. The duration of agonal respiration can be as brief as two breaths or last up to several hours. 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 Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body's acid-base balance. Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys ...

(see Kussmaul breathing, or in general any labored breathing, including Biot's respirations and

ataxic respiration Ataxic respiration is an abnormal pattern of breathing characterized by complete irregularity of breathing, with irregular pauses and increasing periods of apnea. As the breathing pattern deteriorates, it merges with agonal respiration. Cause It ...

s). Correct usage would restrict the term to the last breaths before death. Agonal respirations are also commonly seen in cases of

cardiogenic shock Cardiogenic shock (CS) is a medical emergency resulting from inadequate blood flow due to the dysfunction of the ventricles of the heart.Textbooks of Internal MedicinHarrison's Principles of Internal Medicine 16th Edition, The McGraw-Hill Compan ...

cardiac arrest Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and possi ...

, where agonal respirations may persist for several minutes after cessation of heartbeat. 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.

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Gasping, even the dead breathe
Real footage of a person with cardiac arrest and terminal breathing (gasping) Breathing abnormalities Medical emergencies {{med-sign-stub