Agonal Breathing: A Critical Sign of Cardiac Arrest

Agonal breathing is a distressing and abnormal breathing pattern that occurs in individuals experiencing cardiac arrest or near-death situations. Agonal respiration, characterized by irregular and inadequate gasping, signals the body's desperate attempt to breathe due to insufficient oxygen supply to the brain, highlighting the urgency of recognizing this sign for immediate medical intervention. Recognizing agonal breathing is crucial for bystanders and first responders, as it can be mistaken for normal breathing, leading to delayed or inadequate response during emergencies. As a provider of essential life-saving skills, MyCPR NOW recognizes the significance of understanding agonal breathing and its association with cardiac arrest. In this comprehensive guide, we will explore the characteristics of agonal breathing, its causes, and the appropriate actions to take when encountering this critical sign.

Defining Agonal Breathing

Agonal breathing, often referred to as agonal gasps, is a type of abnormal breathing pattern that occurs as a result of inadequate oxygen supply to the brain. It is typically associated with cardiac arrest, a life-threatening condition where the heart suddenly stops beating effectively. During agonal breathing, an individual may produce gasping, irregular, or labored breaths that may resemble normal breathing. However, breathing agonally involves short, labored gasps of air that resemble snorting rather than normal breathing. Agonal breathing is not effective in oxygenating the body and is a critical sign that the person is in distress and requires immediate attention.

Characteristics of Agonal Breathing

Agonal breathing is characterized by the following features:

1. Agonal Breathing Sound: Agonal breathing often produces gasping or choking-like sounds due to the limited flow of air through the airways. These sounds, known as agonal breathing sounds, can be loud and distressing, often described as snorting, gurgling, or moaning. They are indicative of a severe medical condition, such as cardiac arrest, and are characterized by shallow gasps that are often mistaken for normal breaths.
2. Irregular Pattern: The breaths may be sporadic and irregular, with varying intervals between each gasp. Unlike regular breathing, agonal gasps do not follow a consistent rhythm.
3. Slow Respiratory Rate: The breathing rate may be much slower than normal breathing, often fewer than 12 breaths per minute.
4. Shallow Breaths: Agonal breaths are often shallow, meaning that they do not effectively fill the lungs with air. The chest may barely move, and the breaths may seem weak or labored.

Causes and Signs of Cardiac Arrest in Agonal Breathing

Agonal breathing occurs when the brain is deprived of oxygen due to a sudden stoppage of the heart’s normal pumping function. The lack of blood flow deprives the brain of oxygen, leading to the gasping attempts to breathe. The underlying causes of agonal breathing include:

1. Cardiac Arrest: The most common cause of agonal breathing is cardiac arrest, which may result from various cardiac conditions, such as heart attacks (myocardial infarction), arrhythmias (irregular heartbeats), or heart failure. During cardiac arrest, the heart is unable to pump blood effectively, leading to a sudden drop in oxygen supply to the brain.
2. Near-Drowning Incidents: In near-drowning situations, agonal breathing may occur as a response to the lack of oxygen after being submerged in water. The body’s desperate attempt to breathe after oxygen deprivation can result in agonal gasps.
3. Severe Trauma: Severe injuries, such as those from car accidents, falls, or violent assaults, can lead to significant blood loss or damage to vital organs, interrupting blood flow to the brain and causing agonal breathing.
4. Bleeding Blood Vessel: Conditions like hemorrhagic strokes and cerebral ischemia can cause a bleeding blood vessel, disrupting blood flow in the brain and leading to agonal breathing.
5. Drug Overdose: In some cases, drug overdoses, particularly from opioids, can lead to respiratory depression and cardiac arrest, resulting in agonal breathing. Overdose situations often require immediate administration of naloxone (Narcan) to reverse the effects of opioids and restore normal breathing.

The term 'longer circulating oxygenated blood' refers to the body's failure to adequately supply oxygen to the brain and other organs, usually indicated by agonal breathing. This condition is a critical sign of serious medical emergencies, such as cardiac arrest or stroke, wherein the heart is no longer effectively providing oxygenated blood, leading to life-threatening situations.

Distinguishing Agonal Breathing from Normal Breathing

Recognizing agonal breathing is crucial for bystanders and first responders, as it is often mistaken for normal breathing. The following characteristics help distinguish agonal breathing from normal breathing:

1. Gasping Sounds: Agonal breathing is often accompanied by gasping or choking-like sounds, which are not present in normal breathing. These sounds are typically more pronounced and alarming.
2. Irregular Pattern: Unlike regular breathing, agonal breaths are sporadic, with varying intervals between each gasp. Normal breathing follows a consistent, rhythmic pattern.
3. Shallow and Labored Breaths: Agonal breaths are typically shallow and labored, indicating inadequate breathing that may not effectively fill the lungs with air. In contrast, normal breaths are deeper and more consistent.
4. Lack of Response: Individuals experiencing agonal breathing are unresponsive and do not react to stimuli. Normal breathing is usually accompanied by responsiveness and awareness.

Actions to Take When Encountering Agonal Breathing, Including Chest Compressions

When encountering agonal breathing in an individual, immediate action is crucial to improve the chances of survival:

1. Activate Emergency Response: Call emergency services immediately and request professional medical assistance. Inform the dispatcher about the individual’s condition, including the presence of agonal breathing and unresponsiveness. Provide the exact location and any additional relevant information.
2. Initiate CPR: Start cardiopulmonary resuscitation (CPR) immediately if you are trained to do so. CPR involves chest compressions and rescue breaths, which help circulate oxygenated blood to vital organs and the brain. Follow these steps:
3. Chest Compressions: Place the heel of one hand on the center of the chest (between the nipples) and the other hand on top. Push hard and fast, compressing the chest at least 2 inches deep at a rate of 100-120 compressions per minute. It is crucial to perform CPR chest compressions when encountering agonal breathing.
4. Rescue Breaths: After 30 compressions, give two rescue breaths by tilting the head back, lifting the chin, and breathing into the person’s mouth until the chest rises. Ensure a good seal around the mouth and nose.
5. Use an AED: If an automated external defibrillator (AED) is available, apply it as soon as possible. An AED can analyze the heart’s rhythm and deliver a shock if necessary to restore a normal heartbeat. Follow the device’s voice prompts and instructions:

• Turn on the AED: Follow the voice prompts to attach the electrode pads to the person’s bare chest.
• Clear the Area: Ensure that no one is touching the person while the AED analyzes the heart rhythm.
• Deliver Shock: If advised by the AED, press the shock button to deliver a shock. Immediately resume CPR after the shock. The goal of CPR is to restore a proper heartbeat and ensure effective blood circulation.

Continue CPR: Continue performing CPR and follow the instructions of the AED until emergency medical personnel arrive and take over. Do not stop CPR unless the person shows obvious signs of life, such as normal breathing or movement. Agonal breathing may involve only a few breaths, indicating the urgency of immediate action.

The Importance of CPR Training

Understanding agonal breathing and its association with cardiac arrest highlights the importance of CPR training for everyone. CPR certification equips individuals with life-saving skills and the ability to respond effectively during emergencies. MyCPR NOW offers comprehensive CPR training, teaching participants the proper techniques for performing chest compressions, rescue breaths, and using AEDs. By becoming CPR certified, individuals can be valuable first responders in critical situations, increasing the chances of survival for victims of cardiac arrest and other life-threatening emergencies.

Benefits of CPR Training

1. Confidence in Emergencies: CPR training provides the confidence to act quickly and effectively during emergencies, reducing hesitation and improving response times.
2. Increased Survival Rates: Early CPR can double or triple the chances of survival for cardiac arrest victims by maintaining blood flow and oxygenation until professional help arrives.
3. Community Safety: Widespread CPR training enhances the overall safety and preparedness of the community, creating a network of trained individuals ready to respond to emergencies.

Conclusion

Agonal breathing is a critical sign associated with cardiac arrest, indicating that an individual's heart has stopped beating effectively, leading to inadequate oxygen supply to the brain. Recognizing agonal breathing and understanding its characteristics is essential for bystanders and first responders to take immediate action and provide appropriate life-saving measures. Early initiation of CPR and the use of an AED are crucial in improving the chances of survival for individuals experiencing cardiac arrest.

As a provider of essential life-saving skills, MyCPR NOW encourages individuals to acquire CPR training to be prepared for emergencies like agonal breathing and cardiac arrest. By learning CPR techniques and becoming certified, individuals can make a significant difference in their communities, contributing to safer environments and increasing the likelihood of positive outcomes during life-threatening situations.