Rescue breathing requires that the rescuer inflate the individuals lungs adequately with each breath. It is useless to attempt mouth-to-mouth breathing in any person who breathes through an opening in the neck.
Direct attention to getting air/oxygen through the opening or tube in the neck, and not the individuals mouth.
Mouth to stoma ventilation is performed by the rescuer taking a deep breath and making an airtight seal with his/her lips around the individuals stoma or laryngectomy/tracheostomy tube. The rescuer at first gives two slow, full breaths, about 2 seconds per breath. This is followed by a pulse check, ideally at one of the two carotid arteries situated slightly to either side of the midline of the neck.
Be aware that surgical or radiation treatments might have hardened the tissues, making it difficult to detect a pulse in the neck location of a laryngectomee. If this holds true, attempt an alternate area such the wrist. If a pulse exists, but the person is still not breathing, offer one breath to stoma site every 5 seconds. Appropriate ventilation is suggested by observing the chest fluctuate, and hearing and feeling air escape from the individual throughout exhalation.

The person might have if the chest stops working to increase a blocked laryngectomy/tracheostomy tube. If air is not travelling through the laryngectomy/tracheostomy tube, eliminate the inner tube and resume rescue breathing. The innertube is the lining of the laryngectomy/tracheostomy tube and it is a typical location for an obstruction.

The inner tube can be separated and removed from the outer tube by releasing it from the lock on the neck plate of the tube or turning the inner tube counter clockwise. Each design of laryngectomy/tracheostomy tube has its own locking system.

If you feel or hear air escaping from the mouth and nose, the person is a partial neck breather. To aerate a partial neck breather, the persons mouth and nose normally should be sealed by the rescuers hand or by tightly fitting mask to prevent leakage of air when the rescuer blows into the tracheostomy tube, if the tracheostomy tube has a cuff and it is not necessary to cover the mouth and nose as the cuff will prevent the leakage of air to the mouth and nose.

Alternatives to mouth-to-mouth stoma rescue breathing.

Numerous rescuers choose to use a barrier gadget during mouth-to-stoma breathing. A baby or young child mask size is more than likely to seal around a neck stoma or laryngectomy/tracheostomy tube neck plate.

For mouth to mouth ventilation, there are one-way valve mouth pieces which can be paired to the mask, thereby permitting a rescuer to aerate the individual while preventing direct contact with exhaled air or discharge from then stoma.

The rescuer must utilise one hand to hold down the mask while breathing into the one way valve. Another alternative is to utilise a bag-valve mask system, which consists of a self-inflating bag and a one-way breathing valve attached to an infant or young child mask.
The mask is held strongly over the stoma as the rescuer squeezes the bag to ventilate the individual. It should be kept in mind, however, that in grownups, bag-valve units might provide less ventilatory volume than mouth to stoma or mouth to mask ventilation.

Likewise a single rescuer may have problems providing a leak proof seal to the stoma and squeezing the bag effectively.

Effective ventilation is when two rescuers use these devises: one to hold the mask and one to squeeze the bag. Training is needed to end up being proficient in using an experienced rescuer and the bag-valve mask system needs to use the mouth to stoma or mouth to mask technique of ventilation.

Summary or rescue breathing procedures