The Head Tilt Chin Lift (HTCL) maneuver is a non-invasive, manual technique used in emergency medicine to establish and maintain an open airway for an unconscious person. When an individual loses consciousness, the muscles controlling the tongue and throat relax. This relaxation causes the tongue, which is attached to the lower jaw, to fall backward against the pharynx, blocking the passage of air. The primary purpose of the HTCL maneuver is to reposition the head and jaw to mechanically lift the tongue away from the throat, creating an unobstructed pathway for breathing.
When to Use the Head Tilt Chin Lift
The Head Tilt Chin Lift is a standard procedure used when an adult or child is found to be unresponsive and not breathing normally. This technique is often the first step in basic life support and cardiopulmonary resuscitation (CPR) before initiating rescue breaths. The relaxed tongue is the most common cause of airway obstruction in a supine, unconscious patient, making this maneuver particularly effective.
Before beginning, a rescuer must quickly assess the victim’s state of consciousness and breathing. The technique is implemented immediately if the person is lying on their back, is not responding to verbal or tactile stimulation, and is either not breathing or is only gasping. This initial assessment also establishes if a trauma-related injury might prevent the use of the HTCL.
The HTCL is the preferred method for opening the airway whenever there is no indication of a possible neck or spinal injury. This repositioning of the head is highly effective because it straightens the alignment between the mouth, throat, and trachea, which are the main structures of the upper airway. By moving the lower jaw forward, the attached tongue is pulled forward, which relieves the obstruction.
Performing the Maneuver: Step-by-Step
The execution of the Head Tilt Chin Lift maneuver requires precise hand placement and coordination to achieve the desired anatomical effect without causing harm. The rescuer should position themselves beside the victim’s head while the person is lying flat on a firm surface. This positioning allows comfortable access to both the forehead and the chin.
The rescuer places the palm or heel of one hand directly onto the victim’s forehead. With the other hand, the tips of two fingers, typically the index and middle finger, are placed underneath the firm, bony part of the chin near the jawline. It is important to avoid pressing on the soft tissue located immediately beneath the chin, as pressure here could inadvertently push the tongue further back and worsen the obstruction.
The next step involves a simultaneous two-part motion. Apply gentle but firm downward pressure on the forehead while simultaneously lifting the chin upward and slightly forward. This action extends the neck and tilts the head backward. The backward tilt stretches the neck muscles and soft tissues, resulting in the forward movement of the mandible, which lifts the tongue.
This movement sequence ensures the lower jaw and tongue are moved away from the back of the throat, creating an open passage for air. Once the airway is open, the rescuer must maintain this position to keep the airway patent while checking for signs of breathing. The continued maintenance of the tilt and lift is necessary because the muscles will immediately relax and the tongue will fall back the moment the rescuer releases pressure.
Spinal Injury Precautions and Alternatives
The Head Tilt Chin Lift maneuver should never be used if there is any suspicion that the victim has sustained a neck or spinal cord injury. Tilting the head backward causes movement and hyperextension of the cervical vertebrae in the neck. If a fracture or ligamentous injury exists in the spine, this movement carries a significant risk of causing further damage to the spinal cord, potentially resulting in permanent paralysis.
Indications of a possible spinal injury include a mechanism of injury such as a car accident, a fall from a significant height, or a diving injury. In any scenario where trauma is suspected, the rescuer must prioritize minimizing neck movement. The accepted alternative to the Head Tilt Chin Lift is the Jaw Thrust maneuver.
The Jaw Thrust technique opens the airway by manually moving the lower jaw forward without tilting the head backward. To perform this, the rescuer places their fingers under the angles of the victim’s lower jaw and lifts the jaw forcefully upward and forward. This action pulls the mandible and attached tongue away from the pharynx, achieving airway opening while keeping the cervical spine in a neutral alignment.