Artificial respiration, commonly called rescue breathing, delivers oxygen to a person who is not breathing but still has a pulse. The most immediate step before delivering any breaths is ensuring the airway is completely open, or patent. Proper head positioning is the mechanism used to achieve this open airway, which is fundamental to the success of artificial respiration. This maneuver is prioritized because air cannot enter the lungs if the passage is blocked.
The Primary Goal: Achieving Airway Patency
The necessity of head positioning is rooted in the anatomy of an unconscious person. When a person loses consciousness, the muscles supporting the airway relax entirely. This relaxation allows the tongue, which is attached to the back of the jaw, to fall backward against the pharynx, or throat. This tongue-based obstruction is the most common reason an unconscious person cannot move air, rapidly leading to a lack of oxygen. The physical repositioning of the head and jaw mechanically pulls these soft structures away from the back of the throat, ensuring an unobstructed pathway for air.
Standard Airway Opening Procedure
When there is no suspicion of neck or spinal trauma, the standard method for opening the airway is the Head-Tilt, Chin-Lift maneuver. This technique uses mechanical leverage to reposition the head and jaw, lifting the tongue from the back of the throat. The rescuer kneels beside the person’s head for optimal control.
Place one hand gently on the person’s forehead. Position the fingertips of the other hand under the bony part of the chin. Apply gentle, firm downward pressure to the forehead to tilt the head backward. Simultaneously, lift the chin upward, stretching the neck tissues and moving the lower jaw forward.
For an adult, the tilt should extend the neck past the neutral position to maximize the airway opening. Avoid pressing on the soft tissue underneath the chin, as this can compress the airway. The combined action aligns the oral and pharyngeal axes, creating a straight path for air.
For infants, the head should only be tilted to a “sniffing” or neutral position, as excessive tilting can close their flexible airways. The rescuer must maintain this position throughout the rescue breathing process.
Modifying the Technique for Neck Trauma
If a neck or spinal injury is suspected (e.g., after a fall or car accident), the Head-Tilt, Chin-Lift maneuver must be avoided, as tilting the head risks damaging the spinal cord. The alternative is the Jaw-Thrust maneuver, which opens the airway while minimizing head and neck movement.
To perform this technique, the rescuer kneels at the person’s head and places one hand on each side to maintain a neutral, in-line position. Place the index and middle fingers of both hands under the angles of the lower jaw. Gently but forcefully lift the jaw straight upward and forward, causing it to protrude.
This displacement pulls the tongue away from the pharynx without requiring backward tilt or neck extension. The Jaw-Thrust is physically demanding to maintain, but it is the preferred method when spinal integrity is a concern.
Confirming Effective Airway Opening
After positioning the head, the rescuer must immediately check for spontaneous breathing before initiating rescue breaths. This assessment is performed using the “Look, Listen, and Feel” method.
The rescuer positions their head so their ear is placed over the person’s mouth and nose, while looking toward the chest. Look for visible rise and fall of the chest. Listen for the sound of air entering or escaping. Feel for the flow of exhaled air against the cheek.
This entire check should take no more than ten seconds. If there are no signs of normal breathing, the rescuer can proceed with artificial respiration, knowing the airway is open.