There are three main methods of performing rescue breathing.
1. Mouth-to-mask rescue breathing
This is the recommended form of rescue breathing and uses a simple variation on the jaw thrust method of holding the airway open. The general rules are exactly the same as described later for mouth-to-mouth rescue breathing, but mouth-to-mask rescue breathing should be used whenever possible.
CPR should never be delayed while waiting for a resuscitation mask or oxygen to arrive at the scene. However, resuscitation masks should be carried with you when on patrol.
Backward head tilt is essential but apply with caution if a spinal injury is suspected. The victim’s jaw may be lifted using the ‘pistol grip’ or jaw thrust method.
2. Mouth-to-mouth rescue breathing
Although it is possible for rescue breaths to be performed in different positions, it is customary for the victim to be positioned on their back. Follow the steps below to perform mouth-to-mouth rescue breathing.
- Kneel beside the victim’s head and open their airway by tilting their head back and lifting the jaw using jaw support or jaw thrust (cautiously if a spinal injury is suspected).
- Place your mouth over the victim’s slightly open mouth, sealing their nose with your cheek.
- Blow until you see the victim’s chest rise, then lift your mouth from the victim’s mouth, allowing the air to leave the lungs. At the same time, turn your head and place your ear close to the mouth to listen for, and feel, the air leaving while you watch the chest return to its original position.
- Watch the upper abdomen, and maintain backward head tilt and jaw lift, to ensure that the stomach is not becoming swollen with air (See Distension of the stomach).
The very nature of lifesaving requires that lifesavers be trained and prepared to administer mouth-to-mouth rescue breathing. The International Lifesaving Federation Medical Position 11 (2016) states that CPR for a drowning victim should include both chest compressions and rescue breaths. However, if you are unwilling or unable to perform mouth-to-mouth rescue breathing for a drowning victim, you should do chest compressions only.
3. Mouth-to-nose rescue breathing
Mouth-to-nose rescue breathing is used:
- in CPR of infants, when the lifesaver’s mouth should cover the infant’s mouth and nose
- in cases where severe facial injuries make it the preferred method
- in deep-water rescue breathing
- when a victim’s jaw is tightly clenched
- when the airway operator prefers this method.
The technique for mouth-to-nose rescue breathing is similar to that used for mouth-to-mouth, except that in mouth-to-nose rescue breathing:
- air is blown into the nose
- the mouth must be sealed during inflation. In both methods, the air exits through both the mouth and the nose
- sealing the mouth is achieved by pushing the lips together with the thumb. You can also seal the mouth using the jaw thrust method
- the mouth is then opened after inflation, for air to exit.
The rules for inflating and watching the victim’s chest are the same as in mouth-to-mouth rescue breathing.
Sealing the victim’s airway
Sealing the victim’s nose is necessary during mouth-to-mouth rescue breathing, and this is best done by the lifesaver’s cheek. Occasionally, air will continue to escape from the victim’s nose. In such cases, it is necessary to change to the jaw support method (using ‘pistol grip’) and seal the nostrils with your thumb and forefinger.
If the nostrils are sealed using thumb and forefinger, there is a tendency to lose head tilt, so added care is needed to make sure that this does not happen.