The immediate danger for an unconscious person is the loss of muscle tone in the pharynx, which allows the tongue to fall backward and obstruct the upper airway (hypopharyngeal obstruction). This blockage prevents oxygen from reaching the lungs, leading to rapid oxygen deprivation. The goal of any airway maneuver is to manually reposition the tongue and soft tissues, clearing the path for air to flow. The specific maneuver chosen depends on the circumstances, particularly whether a head, neck, or spinal injury is suspected.
The Primary Maneuver: Head-Tilt, Chin-Lift
The Head-Tilt, Chin-Lift is the standard method for opening the airway in any unconscious person when there is no indication of trauma or spinal injury. This technique is effective because it directly addresses the most common cause of obstruction: the relaxation of muscles in the posterior pharynx. By manipulating the head and jaw, the maneuver lifts the base of the tongue away from the back wall of the throat.
To perform the Head-Tilt, Chin-Lift, the rescuer positions themselves at the person’s head while they are lying flat on their back. One hand is placed on the forehead to apply pressure and tilt the head backward. Simultaneously, the fingertips of the other hand are placed under the bony part of the chin and lifted upward.
This combined action creates hyperextension of the neck, pulling the mandible forward and drawing the tongue base anteriorly. Care must be taken not to press into the soft tissue beneath the chin, as this could compress the airway. The resulting alignment of the oral, pharyngeal, and laryngeal axes allows for the straightest possible passage for air.
The Critical Exception: Jaw-Thrust Technique
The Jaw-Thrust Technique is reserved for situations where a head, neck, or spinal injury is suspected, such as after a fall, diving incident, or motor vehicle accident. The forceful hyperextension of the neck required by the Head-Tilt, Chin-Lift risks moving the cervical vertebrae and damaging the spinal cord. The Jaw-Thrust moves the lower jaw (mandible) forward without tilting the head back.
The rescuer kneels at the person’s head and places their elbows on the ground for stabilization. The index and middle fingers of both hands are positioned under the angles of the person’s lower jaw on each side. The jaw is then grasped firmly and lifted upwards and forward with both hands.
This upward and forward movement of the mandible pulls the tongue and epiglottis away from the posterior pharynx, clearing the airway. The thumbs can be placed on the cheekbones or the chin to help stabilize the head and open the mouth slightly. This action maintains the head and neck in a neutral, in-line position, minimizing the risk of exacerbating a spinal injury. This technique is more challenging to execute effectively than the Head-Tilt, Chin-Lift and often requires two rescuers if rescue breathing is necessary.
Assessing Success and Addressing Persistent Obstruction
After performing the chosen maneuver, the rescuer must immediately assess whether the airway has successfully opened. The standard method involves the “Look, Listen, and Feel” approach for a maximum of ten seconds. The rescuer looks for the rise and fall of the chest, listens for breath sounds, and feels for the flow of air.
If the maneuver is successful, the rescuer can proceed with ventilations if the person is not breathing. If breathing is still absent or obstructed, the next step is to slightly reposition the head and re-attempt the maneuver, as a minor adjustment can often resolve the blockage. If the airway remains obstructed, the rescuer should consider a foreign body blockage and initiate the appropriate chest compression sequence.
If the airway is clear but the person is not breathing, rescue breaths must be initiated immediately. Maintaining the chosen maneuver throughout the rescue breathing sequence is necessary to prevent the tongue from falling back and re-obstructing the airway. The goal is to maintain an open passage to ensure adequate oxygenation until professional medical help arrives.