What About Breathing?

With all this emphasis on chest compressions and limiting off-chest time to 5 seconds, when do we help the patient breath?

New CPR guidelines tell lay population to ignore the breathing altogether. The main reason for this is that the airway part of CPR is the most difficult (jaw-thrust, chin-lift, pinch nose, give two breaths), and the reality is no one wants to make-out with a passed-out stranger anyway!

Healthcare professionals are a different story – you have the skills to bag-valve mask, place supra-glottic airways, and intubate – but the principle remains the same. Circulation is the most important action in a cardiac arrest patient. Start with chest compressions, and unless the patient is intubated, keep doing the 30:2 ratio (compressions:breaths) that you remember from before.

Once an airway is secured, asynchronous ventilation takes over; one breath is now delivered by whoever is manning the airway every 8 seconds irrespective of the chest compressions.

This is so important that the American Heart Association has changed the order of approach to arrest patients. No longer is it “A-B-C, Airway, breathing, circulation,” but now “C-A-B, Circulation, Airway, Breathing”. There is  evidence to suggest that appropriate depths of chest compressions move enough air on their own that the blood flowing through the vessels with your constant CPR is oxygenated enough to support the tissues for quite some time!