Do You Perform CPR If Someone Has a Pulse but Is Not Breathing?

No, standard CPR with chest compressions is not usually performed if a person has a pulse but is not breathing. Instead, provide rescue breathing to deliver oxygen to the lungs while monitoring the person’s pulse and breathing. This condition is called respiratory arrest, and it requires immediate emergency care. However, if you cannot confidently determine whether a pulse is present, follow the appropriate CPR protocol for the person’s age and your level of training.

Recognizing the difference between respiratory arrest and cardiac arrest is essential for choosing the correct lifesaving response. In respiratory arrest, the heart continues to pump blood, but the person cannot breathe adequately. In cardiac arrest, the heart stops pumping blood effectively, requiring immediate CPR and the use of an automated external defibrillator (AED) when available.

This guide explains when to perform rescue breathing instead of chest compressions, how to respond to someone who has a pulse but is not breathing, and when to begin CPR.

What Should You Do If Someone Has a Pulse but Is Not Breathing?

If a person is unresponsive, has a definite pulse, and is not breathing normally, provide rescue breathing and activate emergency medical services (EMS). The exact response depends on the person’s age, your training, and whether you can reliably identify a pulse.

Follow these steps:

1. Check responsiveness: Tap the person’s shoulder and shout to determine whether they respond.
2. Assess breathing: Look for normal chest movement. Occasional gasps, irregular gasping, or agonal breathing do not count as normal breathing.
3. Activate emergency services: Call your local emergency number or direct someone nearby to call. Put the phone on speaker if possible.
4. Check for a pulse if trained: Healthcare professionals should check breathing and pulse simultaneously for no more than 10 seconds. Lay rescuers should not delay emergency care trying to find a pulse.
5. Provide rescue breathing: If a definite pulse is present but breathing is absent or inadequate, provide rescue breaths according to your training.
6. Monitor continuously: Reassess breathing and pulse as appropriate for your training. If the pulse disappears or you cannot confidently detect one, begin CPR according to the relevant protocol.

Important: Do not delay emergency assistance while repeatedly checking for a pulse. If the person is unresponsive and not breathing normally and you cannot confidently establish that a pulse is present, treat the situation as cardiac arrest and follow dispatcher instructions.

What Is the Difference Between Respiratory Arrest and Cardiac Arrest?

Respiratory arrest occurs when a person stops breathing or cannot breathe effectively, while the heart continues to circulate blood. Cardiac arrest occurs when the heart stops pumping blood effectively, causing blood flow to the brain and other vital organs to stop. Respiratory arrest can progress to cardiac arrest if oxygen deprivation continues without treatment.

Understanding the difference helps determine whether a person needs breathing support alone or full CPR with chest compressions and breaths.

According to the American Heart Association’s adult basic life support guidelines, healthcare professionals should begin CPR promptly when an adult is unresponsive, is not breathing normally, and has no definite pulse within 10 seconds of checking.

How Do You Give Rescue Breaths to Someone With a Pulse?

For an adult with a definite pulse but no normal breathing, trained rescuers should provide one breath every six seconds, equivalent to approximately 10 breaths per minute. Each breath should last about one second and produce visible chest rise.

Follow these steps when trained to provide rescue breathing:

1. Position the person: Place them on their back on a firm, flat surface.
2. Open the airway: Use the head-tilt/chin-lift technique unless a suspected spinal injury requires a different approach.
3. Give a breath: Pinch the person’s nose, create a seal over their mouth, and blow for approximately one second while watching for chest rise. Use a pocket mask or bag-mask device if trained and available.
4. Continue breathing support: Give one breath every six seconds for an adult with a pulse and inadequate breathing.
5. Reassess the person: Monitor breathing and pulse according to your training. If the pulse disappears or is no longer definitely detectable, start CPR immediately.

Avoid delivering breaths too quickly or forcefully. Excessive ventilation can cause air to enter the stomach and increase the risk of complications.

For children and infants, the recommended ventilation rate differs. The 2025 resuscitation guidelines specify one breath every two to three seconds for children and infants with a pulse but inadequate breathing. Follow age-specific training and emergency dispatcher instructions.

When Should You Start CPR Instead of Rescue Breathing?

Start CPR when the person is unresponsive, is not breathing normally, and has no definite pulse when a trained healthcare professional checks for one within 10 seconds. If you are an untrained lay rescuer, do not attempt a pulse check; an unresponsive person who is not breathing normally or is only gasping should be treated as being in cardiac arrest.

In this situation, call emergency services, begin chest compressions, and use an AED as soon as it becomes available. For adults, standard CPR involves 30 chest compressions followed by two breaths when the rescuer is trained and able to provide them.

Continue CPR until the person shows signs of life, trained emergency personnel take over, the scene becomes unsafe, or you are physically unable to continue.

Do not mistake gasping for normal breathing. Agonal gasps are irregular, ineffective breaths that can occur during cardiac arrest. They do not indicate that the person is breathing adequately or that chest compressions are unnecessary.

What Causes Someone to Have a Pulse but Not Breathe?

Several medical emergencies can cause respiratory arrest while the heart continues beating. These conditions require prompt emergency assessment and treatment.

Common causes include:

• Opioid overdose: Opioids can suppress the brain’s drive to breathe, causing severe oxygen deprivation before cardiac arrest develops.
• Choking: A blocked airway prevents adequate airflow to the lungs.
• Drowning: Water-related emergencies can cause respiratory failure and oxygen deprivation.
• Drug or alcohol poisoning: Certain substances suppress breathing or impair the nervous system.
• Severe asthma: A serious asthma attack can prevent adequate air movement.
• Neurological emergencies: Stroke, seizures, or brain injuries can interfere with normal breathing.
• Other medical emergencies: Severe respiratory illness, trauma, or complications involving the nervous system can also cause respiratory arrest.

The appropriate response depends on the underlying cause. Emergency responders assess the airway, breathing, circulation, and need for additional treatment.

If an opioid overdose is suspected, administer naloxone if available and follow emergency dispatcher instructions. Continue providing breathing support or CPR as indicated by the person’s condition and your training.

What Mistakes Should You Avoid When Someone Has a Pulse but Is Not Breathing?

Incorrect decisions during respiratory arrest can delay oxygen delivery and increase the risk of cardiac arrest. Avoid these common mistakes:

• Performing chest compressions despite a definite pulse: When a trained rescuer confirms a pulse, the initial priority is appropriate breathing support rather than routine chest compressions.
• Failing to provide breaths: A pulse does not mean the person is receiving enough oxygen. Respiratory arrest requires immediate attention.
• Spending too long checking for a pulse: Healthcare professionals should limit the initial pulse check to 10 seconds. Lay rescuers should not delay care attempting to identify a pulse.
• Mistaking gasping for normal breathing: Occasional gasps are not adequate breathing and can indicate cardiac arrest.
• Delaying the emergency call: Activate emergency medical services immediately and follow dispatcher instructions.
• Ignoring changes in the person’s condition: Respiratory arrest can progress to cardiac arrest. If the pulse is lost or cannot be definitely detected, begin CPR according to the appropriate protocol.

The most important principle is to respond to the person’s actual condition. A person who is not breathing needs immediate emergency care, whether the initial problem involves breathing alone or both breathing and circulation.

Learn How to Recognize Respiratory Arrest and Perform CPR

Recognizing the difference between respiratory arrest and cardiac arrest is an essential basic life support skill. Knowing when to provide rescue breathing, when to begin chest compressions, and how to use an automated external defibrillator (AED) helps rescuers respond appropriately during emergencies. CPR and BLS certification courses teach participants to assess responsiveness, recognize abnormal breathing, provide effective rescue breaths, perform high-quality CPR, and use an AED.

To develop these lifesaving skills, enroll in CPR Washington’s AHA-authorized BLS certification course to learn proper CPR techniques, rescue breathing, and AED use. Healthcare professionals seeking advanced training can also enroll in ACLS and PALS certification courses. With flexible online learning and a convenient in-person skills session, you can train on your own schedule and complete your certification quickly. Get certified with CPR Washington and build the skills and confidence to respond effectively to emergencies.