Agonal breathing reflex - fake breathing

The functions of the lungs and heart go hand in hand. When one stops functioning, the other follows and stops aswell. In lifelessness, both the heart and lungs have ceased to function.

In some cases of cardiac arrest, there may be reflexive breathing movements that can be mistaken for normal breathing if one is not familiar with what an agonal breathing reflex is.

In this article, you will learn to correctly identify the agonal breathing reflex.

What is agonal respiratory reflex?

Agonal breathing reflex is one of the body's last attempts to stay alive. It involves movements in the chest area that, at a quick glance, resemble breathing. However, it has many atypical features, the most important of which is that there is no sensation of airflow. Therefore, both the breathing and the pulsating heart av stopped functioning.

This is what is called agonal breathing reflex and it occurs in about 50% of cases of lifelessness.

How does agonal breathing differ from normal breathing?

In normal breathing, one feels the flow of air through the mouth or nose. The airflow is light and feels like a gentle warmth against the skin.

Agonal breathing reflex is not breathing. There is no sensation of airflow at all. This is the most important difference between normal breathing and the agonal breathing reflex!

What does agonal breathing look like?

Normal breathing is regular and calm. When we breathe normally, the movement of the chest or abdominal area is quite unnoticeable.

In agonal breathing reflex, the chest typically rises forcefully. The movement may be seen from several meters' distance, whereas normal breathing is almost imperceptible.

In agonal breathing reflex, there are usually also long pauses between the movements of the chest. Thus, the movement appears irregular.

Movement may also be observed elsewhere. The upper limbs may move as well as the head. The mouth usually opens in an agonal breathing reflex in a way that makes it look like the person being assisted is breathing like a fish on dry land.

What does agonal breathing sound like?

It's important to be aware that in agonal breathing reflex, there may be sounds even though the actual breathing has already stopped. The sound can be snoring or gasping. So do not let movements or sound mislead you!

What should I do if I observe agonal breathing?

Begin CPR immediately. Agonal breathing reflex is a sign of cardiac arrest.

Note that agonal breathing reflex may continue during the resuscitation. Therefore, do not let the movements observed in the body stop the ongoing resuscitation. Once you have noticed that the person is lifeless, continue CPR until:

• the defibrillator is connected and the device requests to stand clear and not touch the patient for analysis or to deliver a shock
• the paramedics have arrived on the scene, have prepared their equipment, and are asking you to stop the resuscitation
• the person wakes up
• you are so exhausted that you can no longer continue CPR

What if I have assessed the situation wrong?

Begin resuscitation nevertheless. Official guidelines state to start resuscitation if there is uncertainty whether the person is unconscious or lifeless. It is less harmful to compress a potentially beating heart than to not perform resuscitation at all.

Always instruct someone else to fetch a defibrillator to the scene during a resuscitation situation, if one is available nearby. You can't do any harm with a defibrillator. The device can only do good. If the patient is not lifeless, the defibrillator will not deliver a shock.

You can begin CPR and attach the defibrillator to the person's chest with a low threshold.