Agonal respiration is an abnormal pattern of breathing characterized by gasping, labored breathing, accompanied by strange vocalizations and myoclonus

Myoclonus

Myoclonus is brief, involuntary twitching of a muscle or a group of muscles. It describes a medical sign and, generally, is not a diagnosis of a disease. Brief twitches are perfectly normal. The myoclonic twitches are usually caused by sudden muscle contractions; they also can result from brief...

. Possible causes include cerebral ischemia

Cerebral ischemia

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

, extreme hypoxia

Hypoxia (medical)

Hypoxia, or hypoxiation, is a pathological condition in which the body as a whole or a region of the body is deprived of adequate oxygen supply. Variations in arterial oxygen concentrations can be part of the normal physiology, for example, during strenuous physical exercise...

 or even anoxia. Agonal breathing is an extremely serious medical sign requiring immediate medical attention, as the condition generally progresses to complete apnea

Apnea

Apnea, apnoea, or apnœa is a term for suspension of external breathing. During apnea there is no movement of the muscles of respiration and the volume of the lungs initially remains unchanged...

 and heralds death

Death

Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....

.

The term is sometimes (inaccurately) used to refer to labored, gasping breathing patterns accompanying organ failure (e.g. liver failure

Liver failure

Acute liver failure is the appearance of severe complications rapidly after the first signs of liver disease , and indicates that the liver has sustained severe damage . The complications are hepatic encephalopathy and impaired protein synthesis...

 and renal failure

Renal failure

Renal failure or kidney failure describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood...

), SIRS

Systemic inflammatory response syndrome

Systemic inflammatory response syndrome is an inflammatory state affecting the whole body, frequently a response of the immune system to infection, but not necessarily so...

, septic shock

Septic shock

Septic shock is a medical emergency caused by decreased tissue perfusion and oxygen delivery as a result of severe infection and sepsis, though the microbe may be systemic or localized to a particular site. It can cause multiple organ dysfunction syndrome and death...

, and metabolic acidosis

Metabolic acidosis

In medicine, metabolic acidosis is a condition that occurs when the body produces too much acid or when the kidneys are not removing enough acid from the body. If unchecked, metabolic acidosis leads to acidemia, i.e., blood pH is low due to increased production of hydrogen by the body or the...

 (see Kussmaul breathing

Kussmaul breathing

Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis but also renal failure. It is a form of hyperventilation, which is any breathing pattern that reduces carbon dioxide in the blood due to increased rate or...

, 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

Cardiogenic shock

Cardiogenic shock is based upon an inadequate circulation of blood due to primary failure of the ventricles of the heart to function effectively....

 or cardiac arrest

Cardiac arrest

Cardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...

 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.A victim who has agonal gasps and does not respond and has no pulse is in cardiac arrest, agonal gasps are not effective breaths.

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

Death rattle

A death rattle is a medical term that describes the sound produced by someone who is near death when saliva accumulates in the throat. Those who are dying may lose their ability to swallow, resulting in such an accumulation...

.

External links

• http://www.metrokc.gov/health/ems/abstract-agonal.htm About agonal respirations in cardiac arrest