Respiratory arrest occurs when a person’s breathing stops completely, representing a total failure of the respiratory system. This cessation of airflow prevents oxygen from entering the lungs and bloodstream, leading to rapid oxygen deprivation. Since the body’s cells, especially those in the brain, require a continuous supply of oxygen, timely intervention is essential to prevent severe and lasting damage. This life-threatening emergency demands immediate recognition and response to restore ventilation.
Defining Respiratory Arrest
Respiratory arrest is defined as the complete cessation of effective breathing, or apnea. This mechanical failure means no air is moving into or out of the lungs, leading to a rapid drop in blood oxygen (hypoxemia) and a dangerous buildup of carbon dioxide (hypercapnia). This physiological imbalance quickly threatens the function of all vital organs.
Respiratory arrest must be distinguished from cardiac arrest. In respiratory arrest, the heart is typically still beating, and a pulse is present. However, if left untreated, the severe lack of oxygen will cause the heart muscle to fail, and the condition will progress into cardiac arrest within minutes. Recognizing this difference dictates the immediate focus of initial rescue efforts.
Primary Causes and Triggers
Respiratory arrest is triggered by underlying issues that interfere with the body’s ability to breathe. The first cause is an airway obstruction, such as choking on a foreign object or tissue swelling from anaphylaxis. In an unconscious person, the tongue can also lose muscle tone and block the upper airway. Another major cause is central nervous system (CNS) depression, which affects the brain’s control centers regulating breathing. Opioid overdose is a prominent example, as these drugs slow the respiratory drive to cessation.
Respiratory arrest can also result from neuromuscular causes. These conditions paralyze or severely weaken the muscles required for lung expansion, such as the diaphragm and chest muscles, seen in advanced muscular dystrophy or spinal cord injury. The final category involves severe lung diseases, such as an overwhelming asthma attack or severe pneumonia. These conditions cause inflammation and fluid buildup, making gas exchange impossible and leading to the failure of the breathing mechanism.
Immediate Recognition and Response
Recognizing respiratory arrest is time-sensitive, as brain cells begin to die after only four to six minutes without oxygen. The most obvious sign is the complete absence of breathing or a lack of visible chest rise and fall. The person may also exhibit “agonal breathing,” which are ineffective, gasping breaths. The individual will rapidly lose consciousness and become unresponsive due to severe oxygen deprivation. Cyanosis, a bluish discoloration of the skin around the lips or nail beds, is a visual sign of low oxygen, though the absence of breathing remains the most immediate indicator.
The immediate response protocol must be initiated without delay. The first action is to call emergency services (e.g., 911) to dispatch professional medical help. While waiting, a lay rescuer should open the airway by tilting the head back and lifting the chin. If the person is not breathing, rescue breathing should be started immediately, delivering one breath every five to six seconds for an adult. If no pulse is present, the rescuer must immediately transition to cardiopulmonary resuscitation (CPR), combining chest compressions with rescue breaths.
Medical Treatment and Prognosis
Once emergency medical personnel arrive, treatment focuses on restoring ventilation and addressing the underlying cause. Intervention often involves establishing an advanced airway, such as endotracheal intubation, where a tube is placed into the windpipe. This is followed by mechanical ventilation, where a machine takes over breathing to deliver oxygen until the patient’s respiratory drive returns. For drug overdoses, medical teams may administer reversal agents, such as naloxone (Narcan) for opioid arrests. The patient’s long-term prognosis is heavily influenced by the duration of oxygen deprivation, as faster intervention increases the chance of survival and neurological recovery.