If there is evidence of respiration, oxygen must be applied to the mouth and tracheostomy stoma or tube.

If there is no evidence of respiration, the resuscitation team must be called and CPR commenced following a pulse check as per current ALS guidelines.

As with all respiratory arrests, before attempting ventilation, you must attempt to open the patient’s airway. Here, there are two potential airways and first you establish whether the tracheostomy is patent.