CPR is a life-saving procedure performed when a person experiences cardiac arrest (when the heart stops beating). Immediate action, such as maintaining blood flow to the brain and other organs, significantly improves the chance of survival. The use of mouth-to-mouth resuscitation, or rescue breaths, has changed significantly, causing public confusion about current standards. This article clarifies the modern distinction in CPR guidelines and explains when rescue breaths remain necessary.
Hands-Only vs. Conventional CPR: The Modern Distinction
For the average person witnessing an adult suddenly collapse, the current recommendation is often “Hands-Only CPR,” which involves chest compressions without rescue breaths. This approach simplifies the procedure and addresses the hesitation many bystanders feel about providing mouth-to-mouth contact. When a healthy adult suffers sudden cardiac arrest, residual oxygen in the blood is usually sufficient for the first few minutes. Therefore, high-quality chest compressions are the immediate priority to circulate that oxygenated blood to the brain and heart until professional help arrives.
Hands-Only CPR focuses on two steps: immediately calling the emergency number and then pushing hard and fast in the center of the chest (100 to 120 compressions per minute). This compression-only technique is considered as effective as conventional CPR for the initial treatment of a witnessed, sudden collapse in an adult. The simplified approach has increased bystander action rates, which improves patient outcomes. This method is recommended for adults whose collapse is presumed to be of cardiac origin.
Conventional CPR, which combines chest compressions with rescue breaths, remains the standard for trained professionals. A bystander who is trained and confident in performing both compressions and breaths with minimal interruption is also encouraged to use this conventional method. The goal in any cardiac emergency is to minimize interruptions to chest compressions, since blood flow stops instantly when compressions pause.
Scenarios Where Rescue Breaths Remain Essential
Rescue breaths are still performed and remain necessary in specific situations where the underlying problem is a lack of oxygen rather than a primary heart event. When a person collapses due to a respiratory issue, the blood is quickly depleted of oxygen, making the delivery of breaths essential for survival. Therefore, the instruction given by emergency dispatchers depends heavily on the circumstances of the collapse.
Conventional CPR, including rescue breaths, is the standard of care for infants and children because pediatric cardiac arrests are most frequently caused by respiratory failure. In these cases, the prompt introduction of oxygen is necessary to prevent brain damage. Victims of drowning also require immediate rescue breaths to deliver oxygen.
Other scenarios requiring rescue breaths include drug overdose (especially involving opioids) and asphyxiation from smoke inhalation, carbon monoxide poisoning, or choking. In these non-cardiac cases, the person’s body lacks sufficient oxygen to sustain the brain until paramedics arrive. Oxygen delivery through rescue breaths is a life-saving intervention. Trained rescuers, including emergency medical services personnel, are expected to deliver conventional CPR with breaths regardless of the victim’s age or the cause of the emergency.
Safe Delivery of Rescue Breaths
When rescue breaths are required, the correct technique must be followed to ensure air reaches the lungs. After 30 high-quality chest compressions, the rescuer delivers two rescue breaths. The airway must first be opened using the head tilt/chin lift maneuver. This involves gently tilting the head back while lifting the chin to move the tongue away from the back of the throat.
The rescuer then pinches the person’s nose shut, creates a tight seal over the mouth, and delivers a breath lasting about one second. The rescuer must watch for the chest to visibly rise to confirm the breath was successful. If the chest does not rise, the rescuer quickly repositions the head using the head tilt/chin lift and attempts the breath again before immediately returning to compressions. This 30 compressions to two breaths (30:2 ratio) sequence is repeated until the person shows signs of recovery or professional help takes over.