Agonal respiration

Agonal respiration, gasping respiration or agonal breathing is a distinct 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 (inadequate oxygen supply to tissue),[2] 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 and heralds death. The duration of agonal respiration can be as brief as two breaths or last up to several hours.[1]

Not to be confused with Agonal heart rhythm.

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, 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.

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][2][3] 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.[4]

References
  1. Perkin, RM; Resnik, DB (June 2002). "The agony of agonal respiration: is the last gasp necessary?". Journal of Medical Ethics. 28 (3): 164–9. doi:10.1136/jme.28.3.164. PMC 1733591. PMID 12042401.
  2. Islam, Sumaiya A.; Lussier, Alexandre A.; Kobor, Michael S. (2018-01-01), Huitinga, Ingeborg (ed.), "Chapter 17 - Epigenetic analysis of human postmortem brain tissue", Handbook of Clinical Neurology, Brain Banking, Elsevier, 150: 237–261, doi:10.1016/b978-0-444-63639-3.00017-7, ISBN 9780444636393, PMID 29496144, retrieved 2020-12-11 {{citation}}: |editor2-first= missing |editor2-last= (help)
  3. EwyWebster, Gordon A. (2010-01-01), Jeremias, Allen; Brown, David L. (eds.), "CHAPTER 52 - Cardiocerebral Resuscitation, Defibrillation, and Cardioversion", Cardiac Intensive Care (Second Edition), Philadelphia: W.B. Saunders, pp. 652–671, doi:10.1016/b978-1-4160-3773-6.10052-7, ISBN 978-1-4160-3773-6
  4. 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. PMID 1443844. Retrieved 21 February 2015.
  • "Incidence of Agonal Respirations in Sudden Cardiac Arrest". EMD Program. King County, Washington. 30 August 2003. Archived from the original on 10 February 2005. Retrieved 25 June 2012.
  • Bång, Angela; Herlitz, Johan; Martinell, Sven (2003). "Interaction between emergency medical dispatcher and caller in suspected out-of-hospital cardiac arrest calls with focus on agonal breathing. A review of 100 tape recordings of true cardiac arrest cases". Resuscitation. 56 (1): 25–34. doi:10.1016/S0300-9572(02)00278-2. PMID 12505735.
  • Hazinski, Mary Fran, ed. (2011). BLS for healthcare providers (New ed.). Dallas, Tex.: American Heart Association. ISBN 978-1616690397.
  • Gasping, even the dead breathe Real footage of a person with cardiac arrest and terminal breathing (gasping)


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