Gasping respiration, often referred to in emergency medicine as agonal breathing, is an abnormal breathing pattern indicating a profound medical crisis. This irregular and sporadic gasping is a reflex sign that the body’s vital systems are failing, typically because the brain is not receiving adequate oxygen. Recognizing this specific pattern signals an immediate life-threatening emergency.
Recognizing Agonal Breathing
Agonal breathing presents as an extremely slow, labored, and often noisy attempt to breathe, which an observer might mistake for a deep sigh or a struggle for air. The pattern is highly irregular and infrequent, sometimes occurring only once every 10 to 15 seconds. This breathing is not effective, meaning it is not moving enough air to sustain life, and the person displaying it is typically unconscious.
The sounds associated with this pattern are distinctive and can include snorting, gurgling, or a deep, ragged groan. A person may exhibit a slight head tilt or shoulder shrug with each gasp, but these movements are shallow and do not inflate the lungs fully. It is important to distinguish this from true labored breathing or hyperventilation, where the patient is still moving air consistently, or from the “death rattle,” which is a gurgling sound caused by secretions in the throat.
The Involuntary Nature of the Reflex
This unique breathing pattern is not a conscious effort but rather a primitive, involuntary reflex originating in the brain stem. When the brain is starved of oxygen, a condition known as severe hypoxia, the higher centers of the brain begin to fail. The lower, more resilient brain stem takes over, activating the final, desperate attempt to initiate respiration.
This reflex arises from the medulla oblongata, the lowest part of the brain stem responsible for regulating basic life functions. The gasping reflex is a sign that the most basic survival mechanisms are still attempting to function, even as the higher brain is shutting down. Since this mechanism is a reflex, it is ineffective at providing the necessary oxygen exchange required for survival.
Common Life-Threatening Triggers
Gasping respiration is a late-stage sign associated with the failure of the circulatory system to deliver oxygenated blood to the brain. The most common trigger for agonal breathing is sudden cardiac arrest, where the heart’s electrical system malfunctions and it stops pumping blood effectively. Agonal breathing occurs in approximately 40% of out-of-hospital cardiac arrests and indicates a short time elapsed since the heart stopped.
Other severe medical events that can lead to this pattern include cerebral ischemia, a type of stroke where blood flow to the brain is blocked, and severe respiratory failure due to drug overdose or drowning. The presence of this breathing pattern is strongly linked to a sudden collapse and unconsciousness.
Immediate Emergency Action
If you encounter someone who is unresponsive and displaying gasping respiration, immediate and decisive action is required, as this pattern is a sign of cardiac arrest until proven otherwise. The first step is to immediately call emergency medical services (911 or your local equivalent) and clearly state that the person is unconscious and making abnormal gasping sounds. Do not wait to see if the breathing improves.
The emergency dispatcher can guide you through the next steps, which will involve beginning chest compressions. Even if the person is gasping, they are considered not breathing normally and require cardiopulmonary resuscitation (CPR) to circulate blood and oxygen manually. Starting compressions quickly can maintain blood flow to the brain until professional help arrives.
For a lay rescuer, the recommended intervention is “Hands-Only CPR,” which involves pushing hard and fast in the center of the chest. Compressions should be delivered at a rate of 100 to 120 beats per minute, following a rhythm similar to the song “Stayin’ Alive.”