Patients with ineffective breathing patterns such as agonal or Kussmaul breathing are considered to be in respiratory arrest and require immediate attention. There are many causes of respiratory arrest, including but not limited to cardiac arrest and cardiogenic shock. Resuscitate patients in apparent respiratory arrest using either the BLS or ACLS Survey.

Respiratory arrest is an emergent condition in which the patient is either not breathing or is breathing ineffectively.



respiratory arrest bls survey


  • Maintain airway in unconscious patient
  • Consider advanced airway
  • Monitor advanced airway if placed with quantitative waveform capnography
  • Give 100% oxygen
  • Assess effective ventilation with quantitative waveform capnography
  • Do NOT over-ventilate
  • Evaluate rhythm and pulse
  • Defibrillation/cardioversion
  • Obtain IV/IO access
  • Give rhythm-specific medications
  • Give IV/IO fluids if needed
  • Identify and treat reversible causes
  • Cardiac rhythm and patient history are the keys to differential diagnosis
  • Assess when to shock versus medicate



respiratory arrest bls survey

The airways listed in the right column are considered basic airways, while those in the left column are advanced. Oropharyngeal and nasopharyngeal airways, while considered "basic," require proper placement by an experienced caregiver. Advanced airway insertion requires specialized training beyond the scope of ACLS certification. While the placement of advanced airways requires specialized training, all ACLS providers should know the proper use of advanced airways once they are placed. Regardless of airway type, proper airway management is an important part of ACLS.

CPR is performed with the patient lying on their back; gravity will cause the jaw, tongue and tissues of the throat to fall back and obstruct the airway. The airway rarely remains open in an unconscious patient without external support.

The first step in any airway intervention is to open the airway. This is accomplished by lifting the chin upward while tilting the forehead back (Figure 8). The goal is to create a straighter path from the nose to the trachea.

In patients with suspected neck injury, the cervical spine should be protected and a jaw thrust alone is used to open the airway (Figure 9). While the standard practice in a suspected neck injury is to place a cervical collar, this should not be done in BLS/ACLS. Cervical collars can compress the airway and interfere with resuscitation efforts. The provider must ensure an open airway regardless of the basic airway used. The provider is obligated to stabilize the head or ask for assistance while maintaining control of the airway.

lifting chin holding head FIG. 8
jaw thrust open airway FIG. 9
Do NOT over-ventilate (i.e., give too many breaths per minute or too large volume per breath). Both can increase intrathoracic pressure, decrease venous return to heart, diminish cardiac output, as well as predispose patients to vomiting and aspiration of gastrointestinal contents.