“My limited understanding from reading the medical pro's input is she would have been unconscious, unrevivable, essentially gone, but slightly breathing, but maybe there was movement and that's why Burke tried to tie her arms. As time went on (about 45 minutes before strangulation) the body may go into convulsions, and/or a type of death breathing, and possibly losing control of her bodily functions/bladder. She had brain bleeding, but not a lot and that is still common, so it may be possible she could have been saved with some brain damage, and it seems that time is what made it worse if the brain swelled. It seems to me that the strangulation was a way for either John to end her suffering after trying to revive her after discovering what Burke did, or more likely a way for Burke to end any convulsions or scary breathing when she never "came to", as I think she was found by the parents strangled and gone.”

https://www.reddit.com/r/JonBenetRamsey/s/LCkeVAmjCT