Someone Can Be Breathing And Still Need CPR

I’ve taken a few CPR classes, and I admit I walked away with the mistaken impression that a person who needs CPR will be unresponsive and not breathing at all. But a common symptom of cardiac arrest is agonal breathing, which can look like the person is gasping or snoring.

Here is an actor demonstrating what agonal breathing might look like. If you would think “oh, he fell down but he’s breathing, he’s ok,” please know that a person in this situation needs a 000 call and CPR.

This is why CPR classes actually tell you to watch out for a person who is “not breathing normally.” Agonal breathing is not normal breathing; it’s a reflex that happens when the brain is not getting enough oxygen.

In a sense it’s a good sign, because it means the person’s brainstem is still active. People who have agonal breathing during a cardiac arrest are more likely to survive than people who don’t, although the sad truth is that odds are low no matter what.

What to do if you see someone collapse and gasp

If a person collapses in front of you, and they’re gasping, groaning, or snoring, it’s time to take action. (You can skip checking for a pulse, which just takes extra time. If the person is actually alive and well, they will push you away or tell you to stop.) If you have had recent CPR training, do whatever you were trained to do. For most of us, the general advice is to:

• Begin hands-only CPR (fast chest compressions, to the tempo of Stayin’ Alive)

• Have someone call 000

• If possible, have someone look for an AED (automated external defibrillator) device

Arizona’s Sarver Heart Centre notes that agonal breathing may actually be better than mouth-to-mouth resuscitation at getting air into the chest. So there’s no need to breathe into the person’s mouth. Hands-only CPR is the preferred method now anyway.

I learned about agonal breathing thanks to this Twitter thread by Anne Marie Cunningham, a doctor who recently saw someone go into cardiac arrest and initially mistook what was happening. She shared some facts about agonal breathing and linked the video above. She said: “I’m a trained health professional and if I didn’t immediately recognise a cardiac arrest neither might you.”

A defib was brought out. CPR (chest compressions only) continued. Other health professionals and am ambulance arrived. The patient was defibed (shocked) and his heart started and he began breathing normally again.

— Anne Marie Cunningham (@amcunningham) September 17, 2019