How to Clear an Airway During CPR: A Step-by-Step Guide

Airway management is the first step in BLS/ACLS. The goal: patent airway for effective ventilation.

Unresponsive Adult/Child (BLS)

1. Assess Responsiveness & Breathing: Shout, tap, check breathing (scan chest) ≤10 sec.
2. Call for Help / Activate EMS: Get AED.
3. Open Airway — Head Tilt-Chin Lift:
   • One hand on forehead → tilt head back.
   • Fingers of other hand under bony chin → lift chin forward.
   • Do NOT hyperextend neck in suspected trauma. Use jaw thrust instead.
4. Check for Obstruction: Look in mouth. Remove visible object only (finger sweep only if you see it). Blind finger sweeps push objects deeper.
5. Attempt Ventilation: Pinch nose, seal mouth, give 2 breaths (1 sec each, chest rise).
6. If Breaths Don't Go In: Reposition head (re-tilt). Reattempt. If still no chest rise → Chest Compressions (30:2) — compressions may dislodge object.

Conscious Choking (Heimlich Maneuver)

• Adult/Child >1 yr: Stand behind, fist above navel, thumb side in, grasp with other hand, quick upward thrusts. Repeat until object expelled or unconscious.
• Pregnant/Obesity: Chest thrusts (mid-sternum).
• Infant <1 yr: 5 back blows (face down on forearm) → 5 chest thrusts (2 fingers, midsternum). Repeat.

Unconscious Choking

1. Lower to floor. Call EMS.
2. Begin CPR (30 compressions).
3. Before breaths: Look in mouth. Remove visible object.
4. Attempt breaths. Repeat cycles.

Advanced Airway (ACLS)

• Supraglottic (i-gel, LMA) or Endotracheal Intubation.
• Confirm: Capnography (EtCO₂), bilateral breath sounds, chest rise.
• Continuous compressions with asynchronous ventilation (10 breaths/min).

Key Principle: High-quality compressions > airway interventions in early cardiac arrest. Minimize interruptions.