What are the recommended ACLS ventilation rates for rescue breathing in patients with a pulse but no breathing, and for patients with an advanced airway, for both children (including infants) and adults?

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Last updated: October 26, 2026 • View editorial policy

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ACLS Ventilation Rates for Rescue Breathing and Advanced Airway Management

For children with a pulse but no breathing, provide rescue breathing at 1 breath every 2-3 seconds (20-30 breaths/min); for adults, provide 1 breath every 5-6 seconds (10-12 breaths/min). Once an advanced airway is placed, children should receive 1 breath every 2-3 seconds (20-30 breaths/min) with continuous compressions during cardiac arrest, while adults receive 1 breath every 6 seconds (10 breaths/min).

Rescue Breathing (Pulse Present, No Breathing)

Children (Infants and Children)

  • Rate: 1 breath every 2-3 seconds, or approximately 20-30 breaths per minute 1
  • Check pulse about every 2 minutes
  • If heart rate drops below 60/min with signs of poor perfusion, start CPR

Adults

  • Rate: 1 breath every 5-6 seconds, or approximately 10-12 breaths per minute 2
  • Monitor for pulse and adequate perfusion
  • Continue until patient resumes adequate spontaneous breathing or advanced help arrives

Advanced Airway Ventilation During Cardiac Arrest

Children (Infants and Children)

  • Rate: 1 breath every 2-3 seconds, or approximately 20-30 breaths per minute 1
  • Provide continuous chest compressions at 100-120/min without pauses for ventilation
  • The 2020 AHA guidelines specifically state: "When performing CPR in infants and children with an advanced airway, it may be reasonable to target a respiratory rate range of 1 breath every 2-3 s (20-30 breaths/min)" 1
  • Avoid excessive ventilation rates that may compromise hemodynamics

Important nuance: The 2025 guidelines 3 provide more age-specific guidance when available, suggesting that higher rates may be associated with improved outcomes in pediatric arrest, particularly given the preponderance of respiratory etiologies in children. One multicenter study found that ventilation rates of at least 30 breaths/min in children <1 year and at least 25 breaths/min in older children were associated with improved ROSC and survival 4.

Adults

  • Rate: 1 breath every 6 seconds, or approximately 10 breaths per minute 5
  • Provide continuous chest compressions at 100-120/min without pauses for ventilation
  • Use waveform capnography to confirm and monitor endotracheal tube placement
  • Avoid excessive ventilation (too many breaths or too large volumes)

Key Differences Between Pediatric and Adult Ventilation

The fundamental difference stems from the underlying pathophysiology:

  • Pediatric arrests are predominantly asphyxial/respiratory in origin, requiring higher ventilation rates to address the primary problem 3
  • Adult arrests are more commonly cardiac in origin, where excessive ventilation can impair venous return and cardiac output

Critical Pitfalls to Avoid

  1. Hyperventilation in adults: Excessive ventilation rates (>10 breaths/min with advanced airway) increase intrathoracic pressure, decrease venous return, and worsen outcomes 2

  2. Hypoventilation in children: Rates below 20 breaths/min may be inadequate given the respiratory nature of most pediatric arrests 3, 4

  3. Confusing CPR ratios with advanced airway rates: Once an advanced airway is placed, abandon compression-to-ventilation ratios (15:2 or 30:2) and switch to continuous compressions with asynchronous ventilation at the specified rates 1, 6, 5

  4. Pausing compressions for ventilation after advanced airway placement: Compressions should be continuous once the airway is secured 6, 5

  5. Excessive tidal volumes: Deliver just enough volume to produce visible chest rise—approximately 500-600 mL in adults 2

Algorithm for Ventilation Rate Selection

Step 1: Determine if patient has a pulse

  • Pulse present, no breathing → Use rescue breathing rates (see above)
  • No pulse → Proceed to Step 2

Step 2: Determine if advanced airway is in place

  • No advanced airway → Use compression-to-ventilation ratios (30:2 for single rescuer, 15:2 for two rescuers in children)
  • Advanced airway present → Proceed to Step 3

Step 3: Apply age-appropriate continuous ventilation rate

  • Children: 20-30 breaths/min (1 breath every 2-3 seconds) with continuous compressions 1
  • Adults: 10 breaths/min (1 breath every 6 seconds) with continuous compressions 5

References

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