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CPR providers should give rescue breaths with an inflation duration of around about one second, and provide sufficient volume to make the victim's chest rise. Breathe gently and steadily to avoid forceful breaths. The maximum time taken between compressions to provide the two breaths should not exceed 10 seconds. If the breath does not go in, check for obstructions in the mouth. But do not do blind finger sweeps. Reopen the airway and try again, but only try the recommended number of times. For example, do not try six times to get the two breaths in. We can deliver the breaths via the mouth, but also in other ways. Mouth-to-nose ventilations is an acceptable alternative to delivering mouth-to-mouth ventilations. It may be considered if the victim's mouth is seriously injured or cannot be opened, the CPR provider is assisting a victim in water, or a mouth-to-mouth seal is difficult to achieve. Mouth-to-tracheostomy ventilations may be used for a victim with a tube or a tracheal stoma who requires rescue breathing. Barrier devices decrease the transmission of bacteria during rescue breathing in controlled laboratory settings. Their effectiveness in clinical practice is unknown. The Resuscitation Council have carefully considered the balance between potential benefit or harm from compressions-only CPR compared to the standard CPR that includes breaths. As a result, they have recommended that individuals who have been trained to deliver CPR should wherever possible perform rescue breaths and compressions, as this may provide additional benefit to the patient. Particularly for children and for those who've sustained asphyxial cardiac arrest. For example, drowning, and also where EMS could be delayed. Only if rescuers are unable to give rescue breaths should they do compression-only CPR.
Rescue Breaths and CPR: Guidelines and Alternatives
Rescue breaths play a crucial role in CPR. They should be performed correctly and with proper techniques to maximise their effectiveness in saving lives.
Proper Rescue Breath Technique
CPR providers should:
- Give rescue breaths with an inflation duration of about 1 second.
- Provide sufficient volume to make the victim's chest rise.
- Avoid rapid or forceful breaths.
- Limit the time between compressions and breaths to no more than 10 seconds.
Dealing with Obstructions
If a breath doesn't go in:
- Check for obstructions in the mouth, but avoid blind finger sweeps.
- Re-open the airway and try again, but only attempt the recommended number of times.
Alternative Breathing Methods
Rescue breaths can also be delivered through:
- Mouth-to-nose ventilation: An acceptable alternative if the victim's mouth is injured, cannot be opened, or a seal is difficult to achieve, or if the victim is in water.
- Mouth-to-tracheostomy ventilation: Applicable for victims with a tracheostomy tube or tracheal stoma who require rescue breathing.
Barrier Devices
Barrier devices can help reduce bacteria transmission during rescue breathing. However, their effectiveness in clinical practice remains unknown.
Resuscitation Council Recommendations
The Resuscitation Council recommends that individuals trained in CPR should perform both rescue breaths and compressions whenever possible. This is particularly important for children, asphyxial cardiac arrest victims (e.g., drowning), and cases with delayed EMS response. Compression-only CPR should only be performed if rescuers are unable to give rescue breaths.
The latest CPR guidelines are the 2021 UK and European Resuscitation Council guidelines.