When a person is not breathing but still has a pulse, they are experiencing respiratory arrest, which is distinctly different from cardiac arrest. This means the lungs have stopped working, but the heart is still circulating blood, rapidly depleting the body’s oxygen reserves. Immediate intervention is required to provide oxygen to the brain and vital organs before the heart fails, causing cardiac arrest. Providing prompt rescue breaths is the most direct action to prevent this transition.
Recognizing Respiratory Arrest and Calling for Help
The first step is to confirm the scene is safe. Check for responsiveness by tapping the person’s shoulder and shouting, “Are you okay?” If there is no response, immediately call the local emergency number, such as 911, and state that you have an unresponsive person who is not breathing. If a bystander is present, direct them to call for help and locate an Automated External Defibrillator (AED), if one is nearby.
Quickly assess the patient’s breathing and circulation; this should not take longer than 10 seconds total. To check for normal breathing, look for the rise and fall of the chest, listen for air movement, and feel for breath. Irregular gasps or snorts, known as agonal breathing, are a sign of inadequate oxygenation and must be treated as no breathing.
Check for a pulse by placing two fingers on the carotid artery, located in the groove on the side of the neck. If you confidently feel a pulse but the person is not breathing normally, begin rescue breathing without delay. This confirms respiratory arrest, where the heart is beating but the body is not receiving oxygen.
Delivering Rescue Breaths: Step-by-Step Procedure
Once respiratory arrest is confirmed, position the person on their back on a firm, flat surface to ensure effective ventilation. Open the airway using the head-tilt/chin-lift maneuver. This involves placing one hand on the forehead and the fingertips of the other hand under the chin. Gently tilt the head back while lifting the chin to move the tongue away from the back of the throat, which is the most frequent cause of airway blockage.
Pinch the person’s nose shut using the hand on the forehead. Take a normal breath, not a deep one, and create a tight seal by placing your mouth over the person’s mouth. Deliver the first rescue breath steadily over one second, watching the chest to confirm it rises slightly.
Allow the chest to fall completely before delivering the second rescue breath, maintaining the one-second duration. Following these initial two breaths, continue providing one rescue breath every five to six seconds for an adult. This translates to 10 to 12 breaths per minute. A consistent rhythm is important to ensure a steady supply of oxygen.
Sustain the sequence of one breath every five to six seconds until the person begins breathing on their own or emergency services arrive. After performing rescue breathing for two minutes, or about 20 to 24 breaths, briefly pause to re-check the person’s pulse. If the pulse remains but breathing has not returned, continue the rescue breathing cycle, rechecking the pulse every two minutes.
Modifying Care for Specific Scenarios
The standard rescue breathing technique requires modification for suspected opioid overdose, pediatric patients, or trauma. For opioid overdose, the lack of breathing is often the primary cause of cardiac arrest. Opioids depress the central nervous system, causing breathing to become slow or absent, which starves the body of oxygen.
If an opioid overdose is suspected, administer Naloxone (Narcan) immediately, if available, alongside starting rescue breathing. Naloxone temporarily blocks the effects of the opioid, but it can take a few minutes to take effect. Continue to provide one breath every five seconds, as the rescue breathing delivers the necessary oxygen while waiting for the Naloxone to reverse the respiratory depression.
Pediatric Patients
Care for infants (up to one year) and children (one year to puberty) requires a different approach regarding the rate and force of ventilation. For a child or infant not breathing but with a pulse, the recommended rate is one rescue breath every three to five seconds (12 to 20 breaths per minute). This increased frequency is necessary due to the higher metabolic and respiratory rates in younger patients.
When delivering breaths to an infant, cover both the mouth and nose simultaneously to create a proper seal. The breath must be a gentle puff, using only the air in your cheeks, to avoid over-inflating the smaller lungs.
Trauma
If the person has suffered severe trauma, especially to the head or neck, replace the head-tilt/chin-lift maneuver with the jaw thrust maneuver. This technique involves placing fingers under the angles of the lower jaw and displacing the jaw forward to open the airway without moving the neck, minimizing the risk of worsening a spinal injury.
When to Start CPR or Discontinue Intervention
The decision to transition from rescue breathing to full Cardiopulmonary Resuscitation (CPR) depends entirely on the status of the pulse. If, during the periodic re-check every two minutes, you determine the pulse is no longer present, immediately begin chest compressions and transition to CPR. Losing the pulse indicates that respiratory arrest has progressed to cardiac arrest, and the heart requires external assistance to circulate blood.
This transition involves alternating between chest compressions and rescue breaths in a cycle, typically 30 compressions followed by two breaths, until professional help arrives.
Intervention may be stopped under three conditions:
- When trained Emergency Medical Services (EMS) personnel arrive and take over care of the person.
- When the person begins to breathe normally on their own, demonstrating an adequate rate and depth of breathing.
- If the rescuer becomes physically exhausted and is no longer able to continue delivering effective care.
If the person begins to breathe normally, they should be placed in a recovery position to maintain an open airway and prevent aspiration.