Rescue Breathing (Mouth-to-Mouth): Step-by-Step Guide

Expired Air Resuscitation (EAR) / Mouth-to-Mouth provides oxygen to a non-breathing person until advanced help arrives. Current AHA guidelines prioritize compression-only CPR for untrained lay rescuers. Rescue breaths remain critical for drowning, pediatric, and asphyxial arrests.

When to Perform Rescue Breathing

• Trained provider + willing/able
• Drowning, overdose, pediatric arrest, asphyxia
• Advanced airway not yet placed

Step-by-Step (Adult)

1. Ensure scene safety
2. Check responsiveness: Tap/shout "Are you OK?"
3. Call 911 / activate EMS (send someone; get AED)
4. Check breathing: Look/listen/feel ≤10 sec — absent or agonal gasps
5. Open airway: Head tilt–chin lift (jaw thrust if trauma suspected)
6. Pinch nose (mouth-to-mouth) or seal mouth over stoma (neck breather)
7. Give 2 breaths: Each 1 sec, volume to produce visible chest rise (~500–600 mL)
8. Resume compressions: 30:2 ratio (30 compressions, 2 breaths) at 100–120/min
9. Continue cycles until: ROSC, AED ready, advanced help takes over, exhaustion

Key Technique Points

• Chest rise = effective ventilation — if no rise, reposition head, reattempt
• Avoid overventilation: Causes gastric inflation, ↑ intrathoracic pressure, ↓ venous return
• Barrier device: Pocket mask, face shield (reduces disease transmission concern)
• Pediatric (1 yr–puberty): 1 rescuer 30:2; 2 rescuers 15:2; breath rate 20–30/min if pulse present
• Infant (<1 yr): Cover mouth+nose; 2-finger/2-thumb compressions

Compression-Only CPR (Hands-Only)

For untrained bystanders witnessing adult sudden collapse: Push hard/fast center of chest (≥5 cm, 100–120/min) without breaths. Any CPR is better than none.