Delivering Rescue Breaths: Techniques for Two Rescuers

Posted by Sydney Pulse, APRN at 11:00 am 0 Comment Print

Introduction

When a cardiac emergency occurs, effective cardiopulmonary resuscitation (CPR) can mean the difference between life and death. While single-rescuer CPR is commonly taught, two-rescuer CPR provides significant advantages in emergencies. This coordinated approach allows for more efficient delivery of chest compressions and rescue breaths, reducing rescuer fatigue and improving the quality of care provided to the victim.

Rescue breathing, a critical component of CPR, helps supply oxygen to the victim’s lungs when they cannot breathe on their own. When performed by two trained rescuers working in tandem, the effectiveness of these interventions increases substantially. Understanding proper techniques for two-rescuer CPR, particularly the delivery of rescue breaths, is essential knowledge for healthcare providers and anyone who may find themselves in an emergency.

The Importance of Two-Rescuer CPR in Emergency Response

When cardiac arrest occurs, every second counts. The brain begins to suffer damage after just 4-6 minutes without oxygen. Two-rescuer CPR provides more effective circulation and oxygenation than single-rescuer CPR for several key reasons.

First, it eliminates the transition time between compressions and ventilations that occurs in single-rescuer CPR. This means less interruption to blood flow, which is crucial for maintaining perfusion to vital organs. Second, it reduces rescuer fatigue, allowing for higher-quality chest compressions over a longer period. Research demonstrates that compression quality diminishes significantly after just two minutes of continuous effort by a single rescuer.

Additionally, two-rescuer CPR allows for role specialization. One rescuer can focus exclusively on delivering proper chest compressions at the correct rate and depth, while the other concentrates on providing effective rescue breaths with proper technique. This division of responsibilities leads to better overall CPR quality and potentially improved patient outcomes.

Preparation for Rescue Breaths in Two-Rescuer CPR

Before beginning two-rescuer CPR, proper preparation is essential. Both rescuers should quickly assess the scene for safety and determine unresponsiveness in the victim. After confirming the need for CPR and activating emergency medical services, the rescuers should position themselves appropriately – one at the victim’s side for chest compressions and the other at the head for airway management and rescue breaths.

The rescuer responsible for breathing should ensure proper equipment is available if possible. This may include:

• A pocket mask or bag-valve-mask (BVM) device
• Gloves for both rescuers
• Airway adjuncts if available and if rescuers are trained in their use

Personal protective equipment is critical for rescuer safety. When available, barrier devices should be used to prevent direct contact with the victim’s mouth and respiratory secretions. The breathing rescuer should also ensure the victim’s airway is properly positioned using the head-tilt, chin-lift maneuver (or jaw-thrust for suspected cervical spine injuries).

Rescue Breaths Two-Rescuer CPR: Basic Technique

In two-rescuer CPR, the standard compression-to-ventilation ratio for adults is 30:2, meaning 30 chest compressions followed by 2 rescue breaths. However, for healthcare providers performing two-rescuer CPR, the recommended ratio changes to 15:2 for victims of all ages except newborns.

The delivery of rescue breaths requires proper technique to be effective:

1. The compression rescuer completes the designated number of compressions (15 for healthcare providers, and 30 for lay rescuers).
2. After completing compressions, the compression rescuer calls out “Switch” or “Breaths” to signal the transition.
3. The breathing rescuer opens the airway using the head-tilt, chin-lift method.
4. The breathing rescuer delivers the first rescue breath, watching for the chest to rise. Each breath should be delivered over 1 second.
5. If the chest rises, the rescuer delivers the second breath. If the chest doesn’t rise, the airway position should be readjusted before attempting the second breath.
6. The compression rescuer immediately resumes chest compressions after the second breath without delay.

This sequence continues until advanced medical help arrives, the victim shows signs of life, or the rescuers become too exhausted to continue.

Advanced Techniques for Rescue Breaths in Two-Rescuer CPR

For healthcare providers and those with appropriate training, advanced techniques can enhance the effectiveness of rescue breaths during two-rescuer CPR.

Using a Bag-Valve-Mask (BVM) Device

The BVM device is the preferred method for delivering rescue breaths in professional healthcare settings:

1. The breathing rescuer positions themselves at the victim’s head and applies the mask, ensuring a tight seal using the E-C technique (thumb and index finger form an “E” on the mask, while the other fingers form a “C” to lift the jaw).
2. The rescuer squeezes the bag smoothly over 1 second, delivering approximately 500-600 mL of air (enough to cause a visible chest rise).
3. The rescuer watches for chest rise with each ventilation, adjusting technique if necessary.

For optimal results with a BVM, a third rescuer can be employed to maintain the mask seal with two hands while the breathing rescuer focuses solely on squeezing the bag.

Oropharyngeal Airways

For unconscious victims without a gag reflex, an oropharyngeal airway (OPA) can help maintain an open airway:

1. Select the appropriate size by measuring from the corner of the mouth to the earlobe or angle of the jaw.
2. Insert the airway upside down into the mouth, then rotate it 180 degrees as it passes the soft palate.
3. Continue rescue breaths as described above, which should now be more effective with the maintained airway.

Coordination Between Rescuers

Effective communication between rescuers is crucial for high-quality two-rescuer CPR. Clear verbal cues help maintain proper timing and coordination:

1. The compression rescuer should count compressions aloud: “1, 2, 3…” up to the final number (15 or 30).
2. Upon reaching the final compression, the compression rescuer should announce “Switch” or “Breaths” to signal the breathing rescuer.
3. The breathing rescuer should verbally confirm when ventilations are complete, saying “Continue” or “Compressions.”
4. If rescuers need to switch positions due to fatigue, this should be communicated during a ventilation pause with phrases like “Switch positions after this cycle.”

Rescuers should coordinate their efforts to minimize interruptions in chest compressions. The goal is to keep interruptions to less than 10 seconds for any reason, including delivering rescue breaths. This requires practice and efficient movements from both rescuers.

Troubleshooting Common Issues with Rescue Breaths

Even trained rescuers may encounter challenges when delivering rescue breaths. Understanding how to address these issues quickly is essential:

Inadequate Chest Rise

If the victim’s chest doesn’t rise during rescue breaths:

• Reposition the head using the head-tilt, chin-lift method
• Check for and remove any visible airway obstruction
• Ensure a proper seal when using a mask device
• Consider using an airway adjunct if available and if rescuers are trained in its use

Gastric Inflation

Excessive air in the stomach can occur if:

• Breaths are delivered too forcefully
• Breaths are delivered too quickly (faster than 1 second per breath)
• The airway is not properly positioned

To minimize gastric inflation, deliver breaths slowly and provide only enough volume to cause a visible chest rise. Avoid excessive force when squeezing the bag of a BVM device.

Mask Seal Problems

Poor mask seal is a common issue when using face masks:

• Reposition hands to ensure proper E-C technique
• Ensure appropriate mask size for the victim’s face
• Apply downward pressure while lifting the jaw into the mask
• Consider switching to a two-person BVM technique if a third rescuer is available

Special Considerations for Different Patient Populations

Two-rescuer CPR techniques require modification for different patient populations:

Pediatric Victims (1 Year to Puberty)

For pediatric victims, two-rescuer CPR follows these modifications:

• Compression-to-ventilation ratio is 15:2 for healthcare providers
• Compressions should be at least 1/3 the depth of the chest (approximately 2 inches)
• Breaths should be delivered more gently, with only enough force to cause a visible chest rise
• A pediatric-sized BVM should be used when available

Infant Victims (Under 1 Year)

For infant victims, additional modifications include:

• Two-thumb encircling hands technique for chest compressions
• Compression-to-ventilation ratio of 15:2 for healthcare providers
• Compressions should be approximately 1.5 inches deep
• Breaths should be delivered as gentle puffs, using less volume than for adults
• An infant-sized mask should be used

Pregnant Victims

For visibly pregnant victims in late pregnancy:

• Position the woman on a firm, flat surface
• Place a wedge under the right hip to displace the uterus to the left
• Perform chest compressions slightly higher on the sternum if necessary
• Deliver rescue breaths normally

Training and Certification in Two-Rescuer CPR

Regular training and certification in CPR techniques are essential for maintaining proficiency. Healthcare providers typically require certification in Basic Life Support (BLS), which includes comprehensive training in two-rescuer CPR techniques.

Courses typically cover:

• Recognition of cardiac arrest and other life-threatening emergencies
• Proper hand placement and technique for chest compressions
• Correct delivery of rescue breaths
• Coordination between rescuers during two-rescuer CPR
• Use of airway adjuncts and ventilation devices
• Switching between roles without disrupting CPR quality

Training includes both theoretical knowledge and hands-on practice with manikins, allowing rescuers to develop muscle memory for these critical skills.

Conclusion

Effective two-rescuer CPR, with properly delivered rescue breaths, can significantly improve outcomes for victims of cardiac arrest. By understanding the proper techniques, troubleshooting common issues, and maintaining clear communication between rescuers, you can provide high-quality emergency care when it matters most.

Regular practice and updates to your training ensure you remain prepared to respond effectively in emergency situations. The coordination between rescuers during two-rescuer CPR allows for more efficient delivery of both compressions and rescue breaths, ultimately providing better support for the victim’s circulation and oxygenation until advanced medical care arrives.

Ready to Get Certified?

Don’t wait until an emergency happens to learn these life-saving skills. CPR Tampa offers comprehensive American Heart Association training in BLS for Healthcare Providers, ACLS, PALS, and CPR and First Aid courses. All of our classes are stress-free and hands-on, providing you with the confidence and skills needed to respond effectively in emergencies.

Whether you need initial CPR certification in Tampa or BLS certification in Tampa, our experienced instructors will guide you through the process. Our courses include detailed instruction on two-rescuer CPR techniques, ensuring you’re prepared to work effectively as part of a resuscitation team.

Contact CPR Tampa today to schedule your certification or renewal course. When seconds count, make sure you’re prepared to provide the best possible care.

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