When someone's breathing stops, mouth-to-mouth resuscitation is a lifesaving move. Mouth-to-mouth resuscitation, known as rescue breathing or artificial respiration, is a lifesaving first aid technique used to help someone who has stopped breathing or is having difficulty breathing. This comprehensive guide about mouth to mouth resuscitation will discuss the step by step procedure, how mouth to mouth resuscitation works, and how it differs in adult child, and Infants. This page also discussed its history and when it is necessary to perform mouth to mouth Resuscitation.

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How to Perform Mouth to Mouth Resuscitation

Performing mouth-to-mouth requires precision and calmness. Follow these steps to ensure you're doing it correctly:

1. Assess the Situation: Ensure the area is safe by checking for dangers like traffic, fire, or chemicals. Make sure the scene is secure for both the victim and the rescuer.
2. Position the Victim: Place the person on their back on a flat surface, aligning their head with their body. If there's a possibility of spinal injury, avoid moving them unless necessary for lifesaving aid.
3. Open the Airway: Gently tilt the person's head back and lift their chin to open the airway. Remove any visible obstructions like objects or fluids from the mouth or throat.
4. Pinch the Victim's Nose: Before giving rescue breaths, pinch the person's nose shut to ensure air goes into their lungs during mouth-to-mouth resuscitation.
5. Create a Seal with Your Mouth: Cover the person's mouth completely with yours to create a tight seal for effective air delivery.
6. Deliver Rescue Breaths: Trained rescuers should perform cycles of 30 chest compressions followed by 2 rescue breaths. Each breath should last about 1 second, just enough to make the chest rise.
7. Observe Chest Movement: Watch for chest movement after each breath, allowing the person to exhale fully before the next breath.
8. Repeat Rescue Breaths: Continue rescue breaths at regular intervals, until the person breathes on their own or professional help arrives.
9. Monitor the Victim: Keep an eye on the person's condition. If they improve, place them in a recovery position and wait for medical help. If they remain unresponsive and not breathing, continue rescue breaths as part of CPR until help arrives.

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If you are not trained in CPR, perform hands-only CPR: call emergency services and push hard and fast in the center of the chest at 100–120 compressions per minute. Rescue breaths are recommended only if you are trained and confident in giving them.

1. Assess the Situation

Before helping, check the environment for risks like traffic, fire, or chemicals. Look, listen, and smell for dangers. If needed, secure the area by moving hazards or calling for help. A safe environment protects both you and the victim, allowing you to act effectively.

2. Position the Victim

Once you've determined the scene is safe, gently lay the victim flat on their back on a firm surface. Keep their head aligned with their body to open the airway. Avoid moving them if you suspect spinal injuries unless it’s critical to save their life. Proper positioning ensures effective rescue breaths and compressions.

3. Clear the Airway

Tilt the victim’s head back and lift their chin to open the airway. Check for obstructions like vomit or food and remove them gently using your fingers or a cloth. Clearing the airway ensures air can pass into the lungs during rescue breaths.

4. Pinch the Victim's Nose

Before delivering rescue breaths, pinch the victim's nose shut using your thumb and index finger. This prevents air from escaping through the nose during the mouth-to-mouth resuscitation, ensuring that the air you breathe into the victim's mouth enters their lungs.

Thumb-and-finger (E-C) technique

‍Place the thumb and index finger in a “C” shape around the mask connector to maintain a seal, while the remaining fingers lift the jaw to keep the airway open. Used during bag-valve-mask ventilation when providing breaths.

5. Create a Seal with Your Mouth

Place your mouth over the victim's mouth, covering it completely to form an airtight seal. Make sure your lips cover the person's mouth entirely, without any gaps. The seal ensures that when you deliver rescue breaths, the air does not escape and is directed efficiently into the victim's lungs.

6. Deliver Rescue Breaths

Blow into the victim’s mouth for about one second per breath. Watch the chest rise to confirm the air is reaching the lungs. Let the victim exhale fully before giving the next breath. This provides critical oxygen to the body.

7. Observe Chest Movement

After delivering each rescue breath, observe the victim's chest movement. Allow the person to exhale fully before providing the next breath. This step ensures that you are not interfering with the natural breathing process and that the person's lungs empty properly before receiving additional air.

8. Repeat Rescue Breaths

Continue giving rescue breaths at regular intervals. Follow this pattern until the person starts breathing on their own or until professional medical help arrives. The continuous flow of oxygen-rich air will support the person's vital functions and increase their survival chances.

• For adults with a pulse but not breathing: Give 1 breath about every 6 seconds (10 breaths per minute).
• For infants and children with a pulse but not breathing: Give 1 breath every 2–3 seconds (20–30 breaths per minute).
• During CPR with compressions: Provide 30 compressions and 2 breaths, each breath over ~1 second to visible chest rise.

9. Monitor the Victim

While delivering mouth-to-mouth resuscitation, constantly monitor the victim's condition. Observe for any signs of improvement, such as spontaneous breathing or the return of a pulse. If the person starts breathing and has a pulse, place them in the recovery position to keep their airway open and wait for professional medical assistance. However, if the victim remains unresponsive and not breathing, continue providing rescue breaths as part of CPR until additional help arrives.

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What is Mouth to Mouth Resuscitation?

Mouth-to-mouth resuscitation is a lifesaving first aid technique used to help someone who has stopped breathing or is having difficulty breathing. It is a fundamental component of cardiopulmonary resuscitation (CPR), an emergency procedure to maintain blood flow and oxygen supply to vital organs when a person's heartbeat and breathing have ceased. Mouth-to-mouth resuscitation plays a crucial role in situations where a person's breathing or heartbeat has stopped, such as cardiac arrest, drowning, or suffocation.

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When Should You Use Mouth-to-Mouth?

Mouth-to-mouth resuscitation is used when a person is unresponsive and not breathing or only gasping (agonal breathing). It is typically part of CPR in situations like drowning, drug overdose, or respiratory arrest, where oxygen deprivation is the primary issue. This technique ensures oxygen is delivered directly to the victim’s lungs, sustaining vital organ functions until they can breathe on their own or professional help arrives.

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How does Mouth to Mouth Resuscitation Work

Mouth-to-mouth resuscitation works by providing a continuous flow of oxygen-rich air from the rescuer's breath into the lungs of a person who has stopped breathing or is experiencing difficulty breathing. This lifesaving technique helps to restore the oxygen supply to the person's body and vital organs, supporting their chances of survival.

By providing a steady flow of oxygen from one person's breath to another, this lifesaving procedure kick-start the recipient's respiratory system and circulatory functions, buying precious time until professional medical help arrives.

When was Mouth to Mouth Resuscitation Invented?

Mouth-to-mouth resuscitation has early roots, with one of the first documented cases recorded by William Tossach in 1744, who revived a coal miner using mouth-to-mouth. In the 18th century, physician John Fothergill also promoted its use for resuscitation. In the 20th century, Dr. James Elam and Dr. Peter Safar scientifically demonstrated the effectiveness of mouth-to-mouth breathing, helping establish it as a standard lifesaving technique. Modern CPR, which combines chest compressions with rescue breaths, evolved from these advancements. Today, mouth-to-mouth resuscitation remains an important part of emergency response, especially when provided by trained rescuers.

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What is the indication for mouth-to-mouth rescue breaths?

Mouth-to-mouth resuscitation, also known as rescue breathing, is a vital first-aid intervention employed when an individual's respiratory functions are compromised or have ceased altogether. This life-saving technique is indispensable in scenarios involving acute respiratory distress or cardiac arrest. Such critical situations arisea from a multitude of causative factors, including but not limited to, aquatic asphyxiation (drowning), mechanical airway obstruction (suffocation), electrical shock (electrocution), pharmacological toxicity (drug overdose), and physical injuries.

Here are some specific situations where mouth-to-mouth resuscitation is necessary:

• Cardiac Arrest: When a person's heart stops beating, it leads to cardiac arrest. In this situation, the person loses consciousness and stops breathing. Mouth-to-mouth resuscitation is an essential component of CPR to maintain blood flow and oxygen supply to vital organs until professional medical help arrives.
• Drowning: When someone is rescued from drowning, they often have water in their lungs and cannot breathe. Rescue breaths are especially important after drowning, because oxygen is the priority. Do not attempt to clear water from the airway, begin CPR with 30 compressions and 2 rescue breaths immediately.
• Suffocation: In cases of suffocation due to choking, smoke inhalation, or a foreign object blocking the airway, mouth-to-mouth resuscitation restores the person's ability to breathe.
• Drug Overdose: Certain drugs depress a person's respiratory system, leading to breathing difficulties or respiratory arrest. Mouth-to-mouth resuscitation assists in maintaining breathing until medical assistance is available.
• Severe Respiratory Distress: Some medical conditions, such as severe asthma attacks or anaphylaxis, causes respiratory distress, where a person struggles to breathe. Mouth-to-mouth resuscitation helps provide supplemental oxygen in such cases.

It is essential to recognize the signs of respiratory distress or cardiac arrest and respond quickly by initiating mouth-to-mouth resuscitation and other appropriate measures like calling for emergency medical services. Proper training in CPR and mouth-to-mouth resuscitation is crucial to ensure the technique is performed correctly and safely, maximizing the chances of saving a person's life in critical situations.

Trained and untrained individuals approaches emergency situations differently, and the indications for specific actions, including interventions like CPR, vary based on their level of training. Here are some key differences in indications for trained and untrained individuals:

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Trained Individuals:

1. Initiation of CPR: Trained individuals, such as those who have completed basic life support (BLS) or CPR courses, are typically instructed to start CPR if they come across an unresponsive person who is not breathing normally. They follow a sequence of actions, including 30 chest compressions and 2 rescue breaths, based on the specific guidelines they were trained on.
2. Assessment of Breathing and Circulation: Trained individuals are taught to assess the person's responsiveness, check for normal breathing. Depending on their training, they start CPR if the person is unresponsive and not breathing normally.
3. Use of Automated External Defibrillators (AEDs): Trained individuals are often educated on the use of AEDs. If an AED is available, they are instructed to use it to deliver electric shocks to the heart in case of a sudden cardiac arrest.

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Untrained Individuals:

1. Call for Help: Untrained individuals are typically advised to call for emergency medical assistance immediately if they come across someone who is unresponsive and not breathing normally. This is a critical step to ensure that professional help is on the way.
2. Hands-Only CPR: Recent guidelines for untrained bystanders, especially in cases of sudden cardiac arrest in adults, often emphasize hands-only CPR. This involves chest compressions without mouth-to-mouth ventilation. The emphasis is on providing continuous chest compressions at a rate of 100 to 120 compressions per minute, until professional help arrives.
3. Assisting Others: Untrained individuals are encouraged to assist in non-invasive ways, such as staying with the person, providing comfort, and facilitating access for professional rescuers.

How does mouth-to-mouth resuscitation differ between infants, children, and adults?

Mouth-to-mouth resuscitation differs in technique and approach for infants, children, and adults due to their anatomy and physiology variations. Here are the key differences in performing mouth-to-mouth resuscitation for each group:

Infants (0 to 12 months):

• The head should be tilted slightly backward to open the airway, but be cautious not to overextend the neck, as infants have relatively large heads and weaker neck muscles.
• Cover both the infant's nose and mouth with your mouth to create an airtight seal, and deliver gentle breaths lasting about 1 second, ensuring the chest rises visibly.
• Use minimal breath volume and avoid excessive force, as infants have smaller lung capacity.

Children (1 to 8 years):

• Position the child's head slightly backward, lifting the chin to open the airway. The technique is similar to that used for adults.
• Use a mouth-to-mouth technique with both nose and mouth coverage, delivering breaths lasting about 1 to 1.5 seconds, ensuring the chest rises visibly.
• Adjust the breath volume to accommodate the child's size and age.

Adults

• Tilt the adult's head backward, lifting the chin to open the airway like children.
• Use a mouth-to-mouth technique, covering the mouth with your mouth to create an airtight seal. Deliver breaths lasting about 1 to 1.5 seconds, ensuring the chest rises visibly.
• Adjust the breath volume to accommodate the adult's size and lung capacity.

Mouth-to-mouth resuscitation should be performed by individuals who are trained and confident in doing so. If you are not trained in this technique, provide valuable help through hands-only CPR (high quality chest compressions without mouth to mouth breaths) until professional medical assistance is available. Proper CPR training equips individuals with the knowledge and skills to respond effectively during emergencies, improving the chances of saving a life.

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Post-Resuscitation Care

After successful mouth-to-mouth resuscitation and the person has started breathing again, it is crucial to provide appropriate post-resuscitation care and monitor their condition closely. Here are some guidelines to follow:

1. Call for Medical Assistaance: Even if the person has started breathing, it is essential to call for emergency medical assistance immediately. Professional medical evaluation is necessary to determine the underlying cause of respiratory distress and ensure appropriate medical care.
2. Keep the Person Calm and Comfortable: Offer reassurance to the person and keep them calm and comfortable. Provide a safe and supportive environment while waiting for medical help.
3. Share Information with Medical Personnel: When medical help arrives, be prepared to provide information about what happened leading up to the incident, the actions taken during mouth-to-mouth resuscitation, and any other relevant details. This information will aid medical personnel in providing appropriate care.
4. Continue Monitoring Vital Signs: After medical professionals take over, they will continue to monitor the person's vital signs, including heart rate, breathing rate, blood pressure, and oxygen saturation. This ongoing monitoring is essential to accurately assess the person's condition and provide appropriate treatment.
5. Offer Support: If the person is conscious and able to communicate, be supportive and empathetic. Experiencing a medical emergency is distressing, and your emotional support makes a difference.
6. Follow Medical Advice: The medical team will provide further instructions for the person's care and recovery after initial treatment and evaluation. It is crucial to follow their advice and recommendations diligently.
7. Follow-Up Care: After the incident, the person should seek follow-up care with their healthcare provider. Even if the immediate crisis is resolved, addressing any underlying health issues or potential risks is essential to prevent future emergencies.

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Is Mouth to Mouth Resuscitation effective?

Yes. Mouth to mouth resuscitation is an effective way to save lives. However, the effectiveness of mouth-to-mouth resuscitation varies depending on several factors, including the underlying cause of the respiratory failure, the promptness of intervention, and the skill of the person performing the rescue breaths. Mouth-to-mouth resuscitation is an essential component of CPR) but its effectiveness is influenced by the following considerations:

• Timeliness of intervention: The sooner mouth-to-mouth resuscitation is initiated after a person has stopped breathing, the better the chances of success. Immediate intervention helps to maintain oxygen supply to vital organs and tissues, increasing the likelihood of a positive outcome.
• Proper technique: Effective rescue breathing requires proper technique. The rescuer must ensure a proper seal over the person's mouth, deliver breaths with sufficient volume, and allow for adequate chest rise between breaths. Proper training in CPR is crucial for ensuring the correct application of rescue breathing.
• Underlying cause: The effectiveness of rescue breathing is influenced by the underlying cause of respiratory failure. If the cause is related to a reversible condition, such as drowning or drug overdose, prompt and effective mouth-to-mouth resuscitation significantly improve outcomes.
• Adjunctive measures: Mouth-to-mouth resuscitation is often combined with chest compressions in CPR. The combination of rescue breaths and chest compressions helps maintain blood circulation and oxygenation of vital organs.

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Is Mouth to Mouth Necessary for CPR?

Mouth-to-mouth is not always necessary for CPR. In adult cardiac arrest, hands-only CPR (chest compressions without breaths) is often recommended for bystanders. However, mouth-to-mouth is crucial in cases like drowning, choking, or respiratory emergencies, where oxygen delivery is essential. For trained responders or when no barriers exist, combining rescue breaths with compressions provides the best chance of survival.

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When Is It Safe or Unsafe to Perform Mouth-to-Mouth?

It's safe to perform mouth to mouth if the victim is not breathing or only gasping and the rescuer is trained and feels comfortable performing mouth-to-mouth CPR. It's unsafe to perform mouth to mouth CPR if the rescuer has an open wound, illness, or infection that might be transmitted.

What are the Alternatives for Mouth to Mouth Rescue Breathing?

If Mouth to Mouth CPR cannot be performed, here are the alternatives:

• Hands-Only CPR: Focus on chest compressions at a rate of 100-120 compressions per minute. This keeps blood flowing to vital organs.
• Pocket Masks or Barrier Devices: Use these to provide rescue breaths without direct contact.
• Bag-Valve Mask (BVM): A two-person technique using a self-inflating bag to deliver breaths, typically available in medical kits.

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Hands-only CPR, have gained popularity due to their simplicity and effectiveness in specific emergencies. These alternatives are particularly valuable when the rescuer is untrained or uncomfortable performing mouth-to-mouth resuscitation.

The  recent CPR guidelines for adults have shifted toward emphasizing hands-only CPR, especially in cases of sudden cardiac arrest. Hands-only CPR involves chest compressions without mouth-to-mouth ventilation. This change is based on evidence showing that continuous chest compressions alone is effective in providing oxygen to the body and maintaining blood circulation. For infants and children, however, CPR guidelines typically recommend a combination of chest compressions and rescue breaths.

How does the use of a bag-valve mask differ from direct mouth-to-mouth breathing?

Using a bag-valve-mask (BVM) differs significantly from direct mouth-to-mouth breathing (rescue breaths) in both technique and effectiveness. A BVM is a manual resuscitator device trained medical professionals use to provide artificial ventilation to patients who are not breathing or cannot breathe adequately.

When using a bvm mask, it is crucial to create a tight seal by placing the mask over the patient's nose and mouth and using the "thumb-and-finger" technique to ensure adequate ventilation. Proper training and practice are essential to use a BVM effectively and achieve a secure seal during resuscitation.

Can mouth-to-mouth resuscitation be used on a pet like a dog or cat?

Yes, mouth-to-mouth resuscitation is used in Pet CPR, including dogs and cats, in emergencies when they have stopped breathing or are experiencing respiratory distress. For dogs and cats, keep the mouth closed and seal your mouth over the snout to deliver breaths. Breath volume and rate vary by species and size. See our Pet CPR Guide for step-by-step instructions.

What are the Risk and Safety Considerations when giving Mouth to Mouth Resuscitation?

1. Infection Risk: There is a potential risk of transmitting infections through mouth-to-mouth resuscitation. However, the risk is generally considered low. To minimize this risk, rescuers are encouraged to use protective barriers such as face shields or pocket masks when providing rescue breaths.‍
2. Ensuring an Open Airway: Proper head tilt and chin lift techniques should be employed to open the airway before delivering rescue breaths. Ensuring a clear airway is crucial to the effectiveness of mouth-to-mouth resuscitation.‍
3. Adequate Chest Recoil: During chest compressions, allowing for full chest recoil between compressions is important. Inadequate chest recoil compromises blood circulation and decrease the effectiveness of the overall resuscitation effort.‍
4. Appropriate Compression Depth: When combined with chest compressions, rescue breaths should be delivered with sufficient volume to cause visible chest rise. Adequate compression depth and proper ventilation are critical for effective CPR.‍
5. Monitoring for Signs of Recovery: Rescuers should continually assess the person for signs of recovery. If the person begins breathing on their own or shows signs of life, mouth-to-mouth resuscitation is no longer be necessary.

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What are the Common Misconceptions About  Mouth to Mouth Resuscitation?

1. Overemphasis on Mouth-to-Mouth: In recent years, there has been a shift in CPR guidelines for laypersons, placing greater emphasis on high-quality chest compressions. For adults in certain situations, hands-only CPR (chest compressions without mouth-to-mouth ventilation) is recommended.‍
2. Inability to Deliver Adequate Ventilation: Some people worry that they cannot provide adequate ventilation during mouth-to-mouth resuscitation. Training in CPR techniques helps individuals develop the skills and confidence needed to deliver effective rescue breaths.‍
3. Fear of Causing Harm: Rescuers fear causing harm, such as breaking ribs during chest compressions. However, the potential benefits of CPR, especially in life-threatening situations, far outweigh the risks.‍
4. Duration of Rescue Breaths: There  is a misconception about the duration of rescue breaths. Effective rescue breaths involve delivering enough air to cause visible chest rise but should not be excessively prolonged.‍
5. Delay in Starting CPR: Waiting for professional help to arrive before initiating CPR is a misconception. Early intervention is critical, and bystanders should start CPR as soon as possible in case of cardiac arrest or respiratory distress.

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How Many Breaths Per Minute Should Be Given During Mouth-to-Mouth Resuscitation?

For Adults, you should give 10-12 breaths per minute (one breath every 5-6 seconds). For Children/Infants, give 12-20 breaths per minute (one breath every 3-5 seconds). This rate ensures the victim receives sufficient oxygen without overinflating the lungs.

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How Do I Know if Mouth-to-Mouth Is Working?

Mouth-to-mouth is working if:

• The victim's chest visibly rises with each breath, indicating air is reaching the lungs.
• You feel resistance while delivering the breath, showing airflow.
• The victim begins to show signs of improvement, such as spontaneous breathing or movement.

If the chest doesn’t rise, reposition the head (head-tilt, chin-lift) to reopen the airway and try again.

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Is Mouth-to-Mouth Effective in Cases of Cardiac Arrest Without Chest Compressions?

No. Mouth-to-mouth alone is not effective in cardiac arrest. Chest compressions are vital to circulate oxygenated blood. Rescue breaths complement compressions by providing oxygen, but compressions must be performed to maintain blood flow to the heart and brain.

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What Should I Do If There Are Signs of Obstruction During Mouth-to-Mouth?

If there are signs of obstruction during mouth-to-mouth, such as no chest rise, visible objects in the mouth, or resistance when delivering breaths, stop delivering breaths immediately to avoid further complications. Reposition the victim's head using the head-tilt, chin-lift maneuver to reopen the airway. Check the mouth for any visible obstructions, such as food, vomit, or foreign objects, and carefully remove them with your fingers or a cloth if reachable.

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Emergency Medical Response and CPR Training

Emergency medical response, including mouth-to-mouth resuscitation as part of CPR, is critical in the Chain of Survival. The percentage of cardiac arrest victims receiving bystander CPR, including mouth-to-mouth resuscitation, varies depending on the region, community awareness, and the availability of trained individuals. However, studies have shown that bystander CPR rates have been historically low in many parts of the world.

According to the American Heart Association study on the Reappraisal of Mouth-to-Mouth Ventilation During Bystander-Initiated Cardiopulmonary Resuscitation, even though CPR has been promoted for many years, many people who need it don't get it. One reason is that some people hesitate to do mouth-to-mouth breathing during CPR. This makes it less likely for bystanders to do CPR. In some areas, bystander CPR rates have been reported to be as low as 30% or even lower.

Proper CPR training and certification prepare individuals to respond effectively during emergencies, making them invaluable assets in saving lives and improving community resilience. By empowering more people with CPR skills, we create a safer and more prepared society to respond to medical emergencies.


Sources:

• Olasveengen TM, Semeraro F, Ristagno G et al. Basismaßnahmen zur Wiederbelebung Erwachsener (Basic Life Support). Leitlinien des European Resuscitation Council 2021. Notf Rett Med 2021 [Epub ahead of print]: 1-20.

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