When abdominal thrusts fail and a choking person becomes unresponsive and collapses, the immediate life-saving protocol changes completely. The goal transitions to a full resuscitation effort, treating the situation as cardiac arrest caused by a blocked airway. This requires the immediate initiation of modified Cardiopulmonary Resuscitation (CPR).
Recognizing Collapse and Activating Emergency Services
Upon recognizing that a choking person has lost consciousness, carefully lower them flat onto their back on a firm surface. This positioning prevents injury from an uncontrolled fall and provides the necessary foundation for effective chest compressions.
The emergency response system must be activated without delay. If a second bystander is present, they should be directed to call the local emergency number and retrieve an Automated External Defibrillator (AED) if one is nearby. If the rescuer is alone, they should shout for help and immediately activate the emergency call themselves before beginning any physical aid. Initiating contact with emergency medical services (EMS) ensures professional help is en route while immediate interventions are started.
Transitioning to Modified Chest Compressions
Once the emergency call is placed, immediately begin chest compressions following the standard protocol for sudden cardiac arrest. Compressions are the most effective way to address the obstruction. They create artificial pressure inside the chest cavity, acting like an internal abdominal thrust to potentially force the foreign object out.
Place hands in the center of the chest, on the lower half of the breastbone, while kneeling directly over the victim. Compressions must be delivered at a rate of 100 to 120 beats per minute, which is approximately two compressions every second. This rhythm can be maintained by compressing to the beat of a familiar song.
The depth of each compression requires the chest to be pushed down at least two inches, but generally not exceeding 2.4 inches, for an average adult. Allowing the chest to fully recoil after each compression is important, as this allows the heart to refill with blood and maximizes the pressure differential created inside the lungs. The procedure begins with a cycle of 30 chest compressions, which is then followed by the modified airway check and rescue breaths.
Airway Check and Removal of the Obstruction
After completing the initial 30 chest compressions, the rescuer must perform a visual check of the mouth before attempting rescue breaths. This check is the specific modification to standard CPR protocol when the cause of unresponsiveness is known to be choking. The rescuer opens the person’s airway using the head-tilt/chin-lift maneuver and then visually inspects the mouth and throat.
If a foreign object is clearly visible and appears loose, it should be removed with a finger sweep, taking care not to push it further down the throat. However, if no object is seen, the rescuer must not attempt a blind finger sweep, as this action carries a significant risk of inadvertently pushing the obstruction deeper into the airway. The rule is to only sweep if the object is directly in sight and within reach.
Following the visual check, the rescuer should attempt to deliver two rescue breaths, watching the chest to see if it rises. If the chest does not rise with the first breath, this indicates the airway remains blocked, and the head should be quickly repositioned using the head-tilt/chin-lift technique. A second rescue breath is then attempted after the repositioning, as a slight change in head position can sometimes move an obstruction enough to allow air passage.
If the chest still fails to rise after the second attempted breath, the rescuer must immediately return to performing another cycle of 30 chest compressions. The sequence of 30 compressions, visual check, and two attempted breaths is repeated continuously. This cycle continues until the object is expelled and the chest successfully rises with a breath, the person regains consciousness, or emergency medical personnel arrive and assume care.