Feb 5, 2018 
Rescue breathing is a component of CPR—and for some, it’s an off-putting one.
Also called “mouth-to-mouth resuscitation,” rescue breathing was once taught as part of every CPR class. It involves putting your mouth to the mouth of a cardiac arrest victim, and breathing into their mouth—while making sure their airway was clear. The most recent guidelines state that rescuers should perform two rescue breaths for every 30 compressions.
In cardiac arrest, the patient stops breathing and their heart stops beating. Rescue breathing is a technique that sends air into their system, ideally keeping them alive longer while they wait for emergency rescue to arrive.
However, research in 2010 called the effectiveness of rescue breathing into question—especially in situations where a lay bystander is delivering CPR. According to three separate studies, rescue breathing delivered by a layperson did not improve the patient’s chances of survival.
Rescue breathing vs. hands-only CPR
The studies suggested that laypeople are uncomfortable with the idea of putting their mouth on a stranger’s mouth. These days, professionals are trained to do this with a barrier, but how likely are laypeople to carry around a barrier mask just in case?
In addition, mouth-to-mouth resuscitation makes the process of delivering CPR more complicated, and untrained bystanders often did not feel confident doing it. When they did do it, it was frequently not done correctly.
As a result, bystander CPR training programs today often teach a “hands-only” version of CPR that’s easy to do, easy to remember, and does not require rescue breathing. Rescuers have only to push hard and fast in the center of the chest—to the tune of a song with the right cadence, such as Sweet Home Alabama or Stayin’ Alive—until emergency help arrives.
That’s far easier to remember, and bystanders no longer have to get hung up on whether or not to get up close and personal with a stranger. As a result, patients are more likely to get CPR from a bystander if they go into cardiac arrest outside of a hospital—something that can significantly improve their chances of survival.
Why rescue breathing is still taught in CPR
However, more in-depth CPR training programs and those geared to healthcare providers still teach rescue breathing—and there’s good reason for that.
In general, the reason rescue breaths are problematic has less to do with their overall effectiveness—and more to do with bystanders’ unease with the idea of giving mouth-to-mouth to a stranger. In a hospital setting and with trained professionals, CPR with rescue breaths is still the ideal.
There are also a few situations where hands-only CPR is not advisable—and the patient actually does need rescue breaths. These include:
When the initial problem was respiratory failure. Cardiac arrest can happen spontaneously, and it can also happen as a result of respiratory problems. This is the case in drownings, chokings, drug overdoses, severe allergic reactions, asthma attacks, and other traumas. When this happens, the blood is low in oxygen by the time cardiac arrest hits—so hands-only CPR would just be pushing non-oxygenated blood around the patient’s system.
When a young child or infant needs CPR. Unless they have a heart condition, most very young patients have healthy hearts. Most of the time, when a child or infant needs CPR, it’s because of a respiratory problem and not a heart problem. This means the blood is de-oxygenated by the time cardiac arrest happens—similar to an adult drowning or choking victim—and they are likelier to need the rescue breaths.
When someone has been in cardiac arrest for a while. If the patient didn’t collapse in front of you—if you discovered them in their collapsed state and have no idea how long they’ve been in cardiac arrest—chances are they need rescue breaths. That’s because the blood is more likely to be depleted of oxygen after the patient has been in cardiac arrest for a while.
In general, hands-only CPR is certainly better than no CPR at all—especially in situations where a layperson is delivering the CPR. There are certain situations where rescue breaths are necessary—and healthcare providers still need to know how to perform them—but laypeople can still save lives by delivering hands-only CPR.