Rescue breathing is a life-saving intervention used when a person has stopped breathing but still has a pulse, a condition known as respiratory arrest. This situation often arises from events like opioid overdose, stroke, or drowning, where oxygen delivery is urgently required to prevent brain damage. The effectiveness of this technique relies entirely on administering the correct volume of air at the correct rate. Delivering breaths too quickly or too forcefully can be just as detrimental as not providing them at all.
Understanding Effective Breath Delivery
The most important action in rescue breathing is ensuring that each breath is delivered slowly and deliberately, taking approximately one second. This slow pace is designed to avoid forcing air into the stomach, a complication known as gastric inflation. To confirm a successful breath, the rescuer must observe a visible rise of the chest. Overly rapid or forceful ventilation introduces a high risk of gastric inflation, which can cause the victim to vomit, leading to aspiration. Gastric inflation can also put pressure on the diaphragm, making chest compressions less effective.
Standard Rates for Adults and Adolescents
For any adult or adolescent who has a pulse but is not breathing normally, the recommended ventilation rate is one rescue breath delivered every five to six seconds. This translates to a frequency of 10 to 12 breaths per minute. Maintaining this rhythm provides enough oxygenation while preventing the physiological effects of hyperventilation. Rescuers can establish this timing by using a rhythmic count, delivering each breath over one second. This measured approach is used when a victim is in respiratory arrest but not yet in full cardiac arrest. If the victim is also receiving chest compressions, two breaths are administered after 30 compressions, maintaining the same careful volume and pace.
Standard Rates for Infants and Children
The ventilation rate for pediatric patients differs from the adult standard due to their higher metabolic rate. For infants and children who have a pulse but are not breathing, the recommended rate is faster: one rescue breath every two to three seconds, resulting in 20 to 30 breaths per minute. This increased frequency requires a more rapid exchange of oxygen and carbon dioxide. The technique also requires adjustment, as the volume of air needed is significantly less than for an adult. Breaths should still be delivered over one second, using only enough volume to cause a slight, visible chest rise. For infants, a rescuer may need to cover both the mouth and the nose to create an effective seal for ventilation. Consistent monitoring of the pulse is necessary; if the pulse rate falls below 60 beats per minute with signs of poor circulation, full cardiopulmonary resuscitation, including chest compressions, must be initiated.
Adjustments for Specialized Rescue Situations
In certain advanced scenarios, the standard rhythm is modified, particularly when a victim requires continuous chest compressions. When an advanced airway, such as an endotracheal tube, has been placed by a trained medical professional, the delivery of breaths becomes continuous and asynchronous with compressions. For an adult with an advanced airway, the ventilation rate simplifies to a steady one breath every six seconds (10 breaths per minute). The chest compressions are delivered without any pause for ventilation. This continuous rhythm is effective because the advanced airway bypasses the upper airway, eliminating the need to pause compressions or prevent gastric inflation. In situations involving an opioid-associated emergency, immediate ventilation is paramount. The standard adult rate of one breath every five to six seconds is still used. The first responder must also be prepared to administer naloxone per protocol while continuing ventilations until the person begins breathing normally or emergency medical services arrive.