Seeing the chest rise during a rescue breath confirms that air is successfully entering the lungs. This visible chest elevation is the primary sign that ventilation is effective. When a breath is given and the chest does not visibly rise, it signals a complete or near-complete blockage of the person’s airway. This situation is a medical emergency that demands immediate, systematic troubleshooting to ensure oxygenation can occur.
Immediate Action Airway Repositioning
The most frequent reason for a failed initial rescue breath is a technical error, specifically an inadequate head tilt or chin lift maneuver. In an unconscious person, the tongue is the most common obstruction, as muscle relaxation allows it to fall back and block the upper airway. The standard head-tilt, chin-lift technique is designed to move the tongue away from the back of the throat and align the airway.
When the first breath fails to produce chest rise, the rescuer must immediately reposition the victim’s head before attempting the second breath. This involves quickly repeating the head-tilt, chin-lift maneuver to ensure the head is tilted sufficiently backward and the chin is fully lifted. This slight adjustment often corrects minor airway misalignment, opening the path for air to reach the lungs. After repositioning, the rescuer must ensure a tight seal before delivering the second rescue breath, watching closely for chest rise.
Responding to Persistent Failure
If the second breath attempt, even after proper airway repositioning, still fails to make the chest rise, the practitioner must assume the presence of a mechanical obstruction by a foreign body. The CPR sequence must immediately return to chest compressions. The mechanical force of the compressions may help dislodge the foreign object by increasing pressure in the airway.
The cycle continues with 30 chest compressions followed by an attempt to give two rescue breaths, maintaining the standard adult ratio of 30:2. Before each subsequent ventilation attempt, the rescuer should quickly open the person’s mouth and visually inspect for a foreign object.
If a solid object is clearly visible and easily accessible, it should be removed with a finger sweep. However, blind finger sweeps are not recommended, as they can inadvertently push the object deeper into the airway. If an object is not seen, the rescuer should proceed with the two breaths and then quickly resume compressions if the chest still does not rise.
Maintaining Circulation Priority
The primary goal of CPR is to maintain perfusion, the flow of oxygenated blood, to the vital organs, particularly the brain. High-quality chest compressions create this blood flow by manually squeezing the heart between the sternum and the spine. Even when ventilation is complicated by an airway obstruction, interruptions to chest compressions must be minimized to sustain a continuous supply of blood to the brain.
The troubleshooting steps for failed breaths—repositioning the head and checking the mouth for obstruction—must be integrated into the brief pause between compression cycles. Current guidelines emphasize that compressions should be restarted immediately after the two attempted breaths, regardless of chest rise. This prioritization ensures that oxygen already present in the blood is circulated while the rescuer manages the ventilation issue within the established 30:2 compression-to-breath sequence.