Airway Management: Mouth-to-Mouth Rescue Breathing


Airway management is the foundation of basic life support and an essential component of advanced life support. The ability to establish and maintain a patent airway is crucial for the survival of a patient in respiratory distress or cardiac arrest. In this article, we will discuss the importance of airway management and the techniques used to achieve it.


Why is Airway Management Important?

The airway is the passage through which oxygen enters, and carbon dioxide exits the body. When the airway is obstructed, the exchange of gases cannot occur, and the patient may suffer from hypoxia, hypercapnia, and, ultimately, cardiac arrest. Therefore, it is crucial to establish and maintain a patent airway in any patient with respiratory distress or cardiac arrest.


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During a resuscitation effort, the rescue team can provide breaths to the patient using mouth-to-mouth, mouth-to-mask, or bag-mask ventilation until an advanced airway is inserted. The use of an advanced airway, such as a supraglottic airway, laryngeal mask airway, or endotracheal tube, offers a more stable way of providing breaths and should be inserted as early as possible. After the advanced airway is inserted, the compression-to-breath ratio should be adjusted as indicated below.

compression to ventilation ratio


Mouth-to-Mouth Rescue Breathing

Mouth-to-mouth rescue breathing is a basic first aid technique that can save lives. This technique is used when a person is not breathing or not breathing normally. In situations where pocket masks or bag masks are not accessible, mouth-to-mouth rescue breathing may be required during CPR.

Mouth-to-mouth breathing is a highly efficient method of delivering oxygen to the individual's lungs without subjecting the rescuer to a significant risk. The rescuer's exhaled air contains approximately 17% oxygen and 4% carbon dioxide, which is much lower than the 100% oxygen supplied through ventilation with 100% high flow oxygen or the 21% oxygen present in the room air we breathe.


How to Perform Mouth-to-Mouth Rescue Breathing?

  1. Check the scene for safety before approaching the person. Ensure there are no hazards that could endanger you or the person you are trying to help.
  2. Check for responsiveness by tapping the person's shoulder and shouting, "Are you okay?" If there is no response, call for emergency medical help immediately.
  3. To ensure proper breathing, it is necessary to tilt the person's head back and lift the chin in order to open the airway. This allows for air to enter the lungs.
  4. Pinch the person's nose closed and take a deep breath. Place your mouth over the person's mouth and blow into their mouth for one second. This will force air into the person's lungs.
  5. Watch the person's chest to see if it rises. If it does not rise, repeat step 4.
  6. Give the person two breaths and then check for signs of breathing. If the person is still not breathing normally, continue to give rescue breaths until help arrives.


Mouth-to-mouth rescue breathing can be used in many situations, including drowning, choking, and cardiac arrest. It is important to note that the technique should only be used on a person who is not breathing or not breathing normally. It should not be used on a person who is breathing on their own.

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How to Perform Infant Mouth-to-Mouth/Nose Rescue Breathing?

  1. Before performing rescue breathing, ensure the infant is unresponsive and not breathing normally. Tap their foot and speak loudly to check for a response.
  2. Place the infant on a firm surface like the ground or a table. Tilt their head back gently to open their airway.
  3. To perform rescue breathing on an infant, create a seal by placing your mouth over their nose and mouth.
  4. Give two gentle breaths into the infant's nose and mouth, each lasting one second. Watch for their chest to rise and fall with each breath.
  5. After giving two breaths, check for a pulse in the infant's brachial artery for no more than 10 seconds.
  6. Continue giving two breaths, followed by a pulse check until emergency medical services arrive or until the infant begins to breathe normally.


Note: If the infant has an advanced airway in place, such as a laryngeal mask airway or endotracheal tube, ventilation should be given through the airway device rather than the mouth and nose.


Rescue Breathing

In numerous cases, a respiratory arrest occurs before cardiac arrest. This is why it's essential to know how to recognize respiratory problems and take immediate action to prevent cardiac arrest.

If a person of any age is not breathing well or not breathing at all, it's crucial to open their airway using the head-tilt/chin-lift technique and initiate rescue breathing. Refer to the table below for more information on how to perform rescue breathing.

rescue breathing guide

What should you do if rescue breathing is not effective?

If rescue breathing is not effective, it is important to start performing CPR immediately. Cardiopulmonary Resuscitation is a combinationof rescue breathing and chest compressions to circulate blood and oxygen to vital organs and tissues manually. It is a more aggressive intervention than rescue breathing alone and can help to maintain some level of blood flow until advanced medical help arrives. It is important to note that even if rescue breathing appears to be effective, it is still important to closely monitor the person's condition and be prepared to switch to CPR if necessary.


When should you switch from rescue breathing to CPR?

If after two minutes of rescue breathing, the person has not regained a pulse or is still not breathing normally, you should begin chest compressions. Chest compressions are an essential part of cardiopulmonary resuscitation (CPR). It helps keep oxygenated blood circulating throughout the person’s body.


What are some common mistakes to avoid when performing rescue breathing?

Some common mistakes to avoid when performing rescue breathing include: not checking for a response before beginning rescue breathing, using too much force or not enough force when blowing air into the person’s lungs, forgetting to tilt their head back to open the airway, and not switching off chest compressions every two minutes. It is also important to make sure that you are covering both the mouth and nose of the person when giving rescue breaths.


How do you know if the person has regained consciousness and no longer requires rescue breathing?

If a person has regained consciousness and no longer requires rescue breathing, they will usually regain the ability to breathe on their own. Signs that the person is regaining consciousness include:

  • Opening their eyes
  • Making movements such as coughing or speaking
  • Responding to verbal commands


If the person appears to have regained consciousness and is breathing normally, rescue breathing can be discontinued.


What are some possible complications or risks associated with rescue breathing?

Some possible complications or risks associated with rescue breathing include aspiration, which occurs when vomit enters the lungs; trauma to the mouth and throat due to over-aggressive ventilation; and pneumothorax, which is an accumulation of air in the chest cavity. Additionally, failure to properly open the airway can lead to ineffective rescue breathing, leading to further complications. Finally, improper positioning of a person ’s head and neck when performing rescue breathing can lead to spinal injury.

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