What to Do If the Chest Doesn't Rise During CPR

Why chest compressions are more important than rescue breathing

CPR
To open the airway, use the head-tilt, chin-lift method. Rod Brouhard

Traditional steps during cardiopulmonary resuscitation (CPR) include rescue breathing. Sometimes the first rescue breath given CPR doesn't make the chest rise. The process includes opening the patient's airway and blowing air into the lungs. It sounds simple, but opening the airway can be tricky sometimes. What happens, then, if the chest doesn't rise during a rescue breath?

What to Do When the Chest Doesn't Rise

Try again, but only once.

First of all, you shouldn't even try to blow into the patient's airway until you've already started pushing on the patient's chest. And you don't need to try rescue breathing at all unless you're trained in CPR. If you feel comfortable doing rescue breathing, remember to always start with chest compressions first.

Opening the airway is usually done by using the head-tilt, chin-lift method. The intent is to pull the tongue off the back of the throat and let air pass unobstructed. Sometimes it's very hard to get the airway open this way, even when paramedics or EMTs are doing it. So if air doesn't go in on the first try, tilt the head down and back up again, then try another rescue breath.

Why Chest Compressions Are More Important Than Breathing

Whether it works the second time or not, go back to pushing on the chest. It's more important to get the blood moving around the body. There's probably still plenty of oxygen in the bloodstream and only by pushing on the chest will that blood get to the brain and the heart.

In years past, all the focus on delivering those rescue breaths no matter what meant some patients didn't get chest compressions as quickly as they should. The assumption used to be that if air didn't go in, there must be something stuck in the airway that needed to come out before anything else was done.

Now we recognize how difficult it is to open the airway. It doesn't mean there's a chunk of steak in the airway just because the chest doesn't rise. Indeed, in some cases of cardiac arrest, rescuers are encouraged to skip the rescue breathing entirely and provide hands-only CPR. If you're not a professional rescuer who does CPR on a regular basis or someone who is well-trained and comfortable with CPR, you should probably skip the rescue breathing anyway.

It Only Takes Two Breaths

Remember to always start with chest compressions. If you're performing rescue breathing, only two breaths are necessary, whether successful or not. If they both work, great. Resume chest compressions.

If the first one works and the second one doesn't, resume chest compressions. If both of them fail, resume compressions. Regardless of what happens after a second breath or a second try, resume chest compressions. After you've done 30 chest compressions, try two more breaths and repeat.

Simple Steps When You're Not Trained in CPR

Here's what to do if you're untrained or you haven't been trained for a while:

  1. If there is no pulse, do 100 to 120 chest compressions per minute until help gets there
  2. Don't worry about rescue breathing

Steps When You're Trained in CPR

If you're trained in CPR and feel confident in your skills, here's what to do:

  1. Check for 10 seconds to see if the person is breathing and if there's a pulse
  2. If not, push on the chest 30 times
  3. Head-tilt, chin-lift and try a breath
  4. Try another breath
  5. Repeat
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