Recognizing gasping: when abnormal breathing means cardiac arrest

by Frédéric Séguret — 21 February 2018 — last updated 5 February 2026 — 4 min

Present in 30 to 40% of cardiac arrests, gasping is often mistaken for normal breathing. This confusion delays CPR and emergency calls. Here’s how to recognize it and respond.

Contents

Gasping, also known as agonal breathing, refers to a series of abnormal respiratory movements caused by oxygen deprivation to the brain. These breaths are ineffective, slow and irregular. They may be noisy (snoring, gurgling, moaning) or quieter, resembling sighs.

Gasping is not rare: it occurs in 30 to 40% of out-of-hospital cardiac arrests. Because these movements can appear deep and pronounced, they are often mistaken for normal breathing. Gasping typically occurs in the first few minutes following cardiac arrest, then gradually diminishes.

Gasping must be considered as an absence of breathing. Cardiopulmonary resuscitation (chest compressions and rescue breaths) should be started immediately if gasping is recognized, as well as in case of doubt. Compression-only CPR is also effective if the rescuer is unwilling or unable to perform rescue breaths.

Why is it so difficult to recognize?

Misinterpretation of gasping remains the main barrier to cardiac arrest recognition by bystanders. Many people, including healthcare professionals, may confuse these movements with normal breathing, which delays the initiation of CPR.

A brief period of seizure-like movements may also occur at the onset of cardiac arrest. Once these movements stop, if the victim is unresponsive and not breathing normally, cardiac arrest should be assumed and CPR should be started.

Dispatcher assistance

If in doubt about the presence of gasping, the emergency dispatcher can help the caller identify abnormal breathing during the call. The ERC 2025 guidelines recommend calling emergency services as soon as a person is found unresponsive, even before fully assessing their breathing.

A sign of better prognosis

Recent studies show that the presence of gasping is associated with improved survival: patients who exhibit gasping during resuscitation are approximately three times more likely to survive with a favorable neurological outcome. This highlights the importance of not prematurely stopping CPR in a victim who is gasping.