Cardiopulmonary resuscitation (CPR) is an emergency procedure performed when a person is unresponsive and not breathing normally or is only gasping. Effective CPR balances chest compressions, which circulate blood, and ventilations (rescue breaths), which provide oxygen. Ventilation is necessary when a person is not breathing or is breathing inadequately, even if a pulse is present. Guidelines from organizations like the American Heart Association (AHA) define the specific frequency and ratio for delivering these breaths. These standards maximize the chances of a successful outcome by ensuring adequate blood flow and oxygen supply to vital organs.
Standard Ventilation Frequencies for Single Rescuers
When a single rescuer performs CPR on an adult (age 12 or older), the required compression-to-ventilation ratio is 30:2. The rescuer delivers 30 chest compressions followed by two rescue breaths, then immediately returns to compressions. This 30:2 ratio is maintained until emergency medical services take over or the patient recovers. The two rescue breaths should be delivered quickly, each lasting about one second, and the entire pause for ventilation must not exceed 10 seconds.
Respiratory Arrest Ventilation Rates
The 30:2 ratio also applies to single rescuers for children (age 1 to puberty) and infants (under age 1). However, ventilation differs significantly if the patient has a pulse but is not breathing normally (respiratory arrest). In these cases, the rescuer provides only rescue breaths without compressions. For an adult in respiratory arrest, the rate is standardized at one breath every 6 seconds (10 breaths per minute). This rate mimics slow breathing and avoids hyperventilation. For children and infants with a pulse but inadequate breathing, the required rate is faster: one breath every 2 to 3 seconds (20 to 30 breaths per minute). This higher frequency is necessary because pediatric patients have a higher metabolic rate and often suffer cardiac arrest due to primary respiratory issues.
Integrating Ventilation and Compression During Team CPR
When two or more trained rescuers are present (Team CPR), the ventilation frequency changes, especially for pediatric patients. For adult cardiac arrest, the compression-to-ventilation ratio remains 30:2. One rescuer focuses on high-quality chest compressions, while the second delivers the two ventilations during the brief pause after the 30th compression. The primary goal is maintaining continuous compressions with minimal interruptions.
Pediatric Team CPR Ratio
A major difference in Team CPR occurs when resuscitating children and infants. For these age groups, the ratio shifts from 30:2 to 15 compressions followed by two ventilations (15:2). This change reflects the differing causes of cardiac arrest. Adult arrests are typically cardiac events requiring immediate mechanical support. Conversely, cardiac arrest in children and infants is often caused by respiratory failure or shock, leading to a severe lack of oxygen. The 15:2 ratio provides a higher proportion of breaths, ensuring more frequent oxygen delivery to address the underlying respiratory issue and meet the higher metabolic demands of pediatric patients.
Ventilation Rates When an Advanced Airway is in Place
The most significant change in ventilation frequency occurs when specialized healthcare professionals secure an advanced airway device (e.g., endotracheal tube). This device creates a sealed connection to the lungs, eliminating the need to pause chest compressions for ventilation. Once a definitive airway is in place, ventilations are delivered asynchronously, meaning breaths are given continuously without interrupting compressions.
Asynchronous Ventilation Rates
For adults with an advanced airway, the ventilation rate is standardized at one breath every 6 seconds (10 breaths per minute). This continuous, lower rate provides adequate oxygenation while avoiding hyperventilation, which can increase chest pressure and reduce the effectiveness of compressions. For pediatric patients (infants and children), the asynchronous rate is considerably higher: one breath every 2 to 3 seconds (20 to 30 breaths per minute). This difference reflects the pediatric patient’s greater need for oxygenation and addresses the common respiratory causes of cardiac arrest in this population. Continuous, asynchronous breaths ensure that high-quality chest compressions (100 to 120 per minute) are never halted, optimizing circulation and oxygenation simultaneously.