A victim who has a pulse but is not breathing on their own needs only rescue breathing, not full CPR. This is the key distinction: if the heart is still beating (pulse present) but the person has stopped breathing or is only gasping, rescue breathing alone can keep oxygen flowing to the brain and organs until normal breathing returns or advanced help arrives. A victim in full cardiac arrest, with no pulse and no breathing, needs chest compressions combined with breaths.
Why a Pulse Changes Everything
CPR combines chest compressions with rescue breaths because it addresses two problems at once: a heart that has stopped pumping and lungs that have stopped working. When you find someone unresponsive and confirm they still have a pulse, the heart is handling circulation on its own. The only missing piece is oxygen getting into the lungs. Providing breaths without compressions solves that single problem without interfering with a heart that’s already doing its job.
Common scenarios where someone has a pulse but isn’t breathing include opioid overdoses, drowning, severe allergic reactions, and certain poisonings. In each case, the brain’s drive to breathe gets suppressed or the airway becomes blocked, but the heart continues to beat, at least initially.
How to Confirm a Pulse Is Present
Before deciding between rescue breathing and full CPR, you need to check for a pulse. The location depends on the victim’s age. For adults and children, feel for a pulse on the side of the neck at the carotid artery. For infants, press gently on the inside of the upper arm to find the brachial pulse. Spend at least 5 seconds checking but no more than 10. If you can’t confidently feel a pulse within that window, start full CPR.
For infants and children specifically, if you detect a pulse but it’s below 60 beats per minute and the child shows signs of poor circulation (pale skin, no responsiveness), treat the situation like cardiac arrest and begin chest compressions despite the presence of a pulse.
Rescue Breathing Rates by Age
The rate of rescue breathing differs for adults versus children and infants:
- Adults: 1 breath every 5 to 6 seconds, which works out to 10 to 12 breaths per minute.
- Children and infants: 1 breath every 2 to 3 seconds, or about 20 to 30 breaths per minute.
Each breath should last about 1 second and deliver just enough air to make the chest visibly rise. Blowing too hard or too fast forces air into the stomach instead of the lungs, which can cause vomiting and make the situation worse. A slow, steady breath over one full second keeps pressure low enough that air goes where it needs to go.
What Counts as “Not Breathing”
This is where many rescuers get tripped up. A victim who is gasping, gurgling, snoring, or making occasional moaning sounds is not breathing normally. These irregular efforts, called agonal gasps, are a reflex triggered by a brain that’s running out of oxygen. They look alarming and can easily be mistaken for real breathing, but they do not move enough air to sustain life.
If the victim has a pulse and is gasping, provide rescue breathing. If the victim has no pulse and is gasping, that’s cardiac arrest, and they need full CPR with chest compressions. The gasping itself is actually a sign the brain is still active, which means quick action can make a real difference in survival.
Reassessing Every 2 Minutes
While giving rescue breaths, pause every 2 minutes to recheck the pulse. You’re watching for two possible changes. First, the victim may start breathing on their own, meaning you can stop and place them in a recovery position. Second, the pulse may disappear, meaning the heart has stopped and you need to switch immediately to full CPR with compressions.
This two-minute check is critical because respiratory arrest frequently progresses to cardiac arrest. A person who initially only needed breathing support can deteriorate quickly, especially if the underlying cause (like an overdose or allergic reaction) isn’t reversed.
Opioid Overdose: A Common Example
Opioid overdoses are one of the most frequent real-world situations where rescue breathing applies. Opioids suppress the brain’s breathing drive, so a person may become unresponsive with slow, shallow breaths or no breathing at all while their heart continues to beat. The American Heart Association’s protocol for suspected opioid poisoning calls for opening the airway, providing rescue breathing, and administering naloxone if available. Naloxone reverses the opioid’s effect and can restore normal breathing within minutes.
If at any point the person loses their pulse or you aren’t sure whether a pulse is present, switch to full CPR. With overdoses, acting quickly with rescue breaths can bridge the gap until naloxone takes effect or paramedics arrive.
Why Exhaled Air Works
A natural question people have about rescue breathing is whether the air you exhale contains enough oxygen to help. Room air is about 21% oxygen. The air you breathe out during rescue breathing contains roughly 16 to 17% oxygen. That’s lower than fresh air, but it’s more than enough to sustain someone whose lungs are otherwise not working. The alternative, no oxygen at all, leads to brain damage within minutes. Even this reduced concentration keeps vital organs alive while you wait for the situation to resolve or help to arrive.