How to tell if someone is really breathing or just gasping

If you ever have to call 000 for a medical emergency one of the most important questions they will ask you is, “Is the person breathing?”

How you answer that question and whether you are right or wrong, can literally be the difference between life and death.

This is because there is a little known condition that can happen to someone after a cardiac arrest where they go into what is called 'agonal breathing'. (Agonal simply means in this case - like agony! That's what the body is suffering!)

What is 'agonal breathing' and why is it not really breathing at all?

'Agonal breathing' is not really breathing at all. It is simply the body trying to gasp for air. But because it can look like breathing and sometimes even sound like breathing, it is often mistaken for normal breathing and this can have fatal consequences. Especially if you see it and tell the Triple Zero operator - 'Yes, the person is breathing"!

'Agonal breathing' often occurs after your body suffers a serious medical episode like a cardiac arrest or a stroke. Despite the fact it mimics breathing, it is actually a 'near-death' experience where the body is making desperate, involuntary attempts to get oxygen to your brain. It is not true breathing and it is a sign you must get that medical help on the way urgently.

What causes the body to start 'agonal breathing'?

When you suffer a cardiac arrest or stroke, your heart suffers effectively an 'electrical fault' which throws its regular rhythm out. As the heart and lungs normally work together to keep oxygenated blood flowing through your body, when your heart stops doing its regular job, your lungs get thrown out of their rhythm too. This combination of your heart and lungs not working properly together is what triggers the body into involuntary action.

Agonal breathing is a type of gasping often compared to a fish being out of water. The person will suddenly let out a huge gasp as the body desperately tries to suck in some oxygen by expanding the lungs and chest, but then the lungs will collapse quickly again and there will be no more breath for a while. Then after a short period of time, the person will gasp again and so on. Gradually this keeps subsiding even though it can go on for up to 8 minutes. Eventually it stops and when it does, the person is dead.

What are the consequences of not understanding agonal breathing?

The problem with agonal breathing is this. If you don't know what it is and you see someone who is gasping for air, when the Triple Zero operator asks you if they are 'breathing', you will say 'Yes"! Because it sort of looks like breathing.

You think 'not breathing' means not breathing at all! Total silence and no chest movement.

But the question the operator should really be asking you is “are they breathing NORMALLY”. Because if anyone you are helping with first aid is not breathing normally, the most immediate action you must always take is to start CPR straight away.

But if you look at the person and think, 'well they seem to be breathing every now and then, i'll just wait for the ambulance' the person's chances of dying before it arrives increase dramatically.

What to do with someone who is doing agonal breathing?

If you find yourself confronted with someone who has collapsed and you don’t know why, but the person is acting like a fish out of water, gasping for air intermittently, then you can be pretty certain this is agonal breathing. Which means they are not really breathing at all.

The first solution is to apply CPR fast. This means you take over the function of breathing for them, by compressing their lungs and pumping their heart to keep oxygenated blood flowing through the body. Now they may keep gasping as you apply CPR but their chance of survival will be much higher if you keep supplementing that gasping with real CPR. (And even mouth to mouth or 'rescue breaths' if you are comfortable doing that.)

If you don't apply CPR to someone who is suffering agonal breathing, because you mistake it for real breathing, then that person only has a few minutes to live. And many of their vital organs will start suffering irreversible damage after only a minute or two. Agonal breathing is a sign the person is in their death throes, the final few minutes of life.

Note, even better for a person suffering from agonal breathing is to get an AED or 'defibrillator' onto them to reset their heart. If you do, their chances of survival will increase even more than if you only apply CPR.

Hope this article has helped you understand what agonal breathing is and how it is just gasping not real breathing.