The head-tilt chin-lift is the most basic and effective way to open an unconscious person’s airway. It takes two hands, about three seconds, and no equipment. When someone loses consciousness, the tongue and soft tissues in the throat can collapse backward and block the airway. This maneuver physically pulls those tissues forward so air can pass through.
Step-by-Step Technique
Start with the person lying flat on their back on a firm surface. Kneel beside them, near their head.
- Place one hand on the forehead. Use your palm to gently press down and tilt the head backward. This extends the neck.
- Place your fingertips under the bony part of the chin. Use the index and middle fingers of your other hand. Hook them under the jawbone itself, not into the soft tissue underneath.
- Lift the chin upward. While keeping pressure on the forehead with your first hand, use your fingers to pull the chin up and forward. The jaw should rise until the teeth are nearly together or slightly apart.
That’s the complete maneuver. You should see the head tilted back slightly, the chin pointing upward, and the neck gently extended. If the person needs rescue breaths during CPR, you maintain this position with one hand while delivering breaths.
Why It Works
When a person is unconscious, the muscles that normally hold the tongue in place go slack. The tongue falls backward against the rear wall of the throat, creating a seal that blocks airflow. The head-tilt chin-lift counters this in two ways: tilting the head back stretches the front of the throat open, and lifting the chin pulls the jawbone forward, which drags the base of the tongue away from the airway. Together, these movements create a clear path from the mouth and nose down to the lungs.
The 2025 American Heart Association guidelines confirm it as an effective technique for opening an airway, supported by both real-world resuscitation experience and imaging studies.
The Most Common Mistake
The single biggest error is pressing your fingers into the soft tissue under the chin rather than gripping the bony edge of the jawbone. This is an easy mistake to make in a stressful moment, but it does the opposite of what you want. Pushing into the soft area beneath the chin compresses the airway from the outside and can make the obstruction worse.
Keep your fingers on bone only. Feel for the hard ridge along the bottom of the jaw and hook your fingertips there. If you’re pressing into anything that feels squishy, reposition your fingers.
Another common error is not tilting the head back far enough. A timid, half-hearted tilt often leaves the tongue partially blocking the airway. You want a deliberate backward tilt of the head, enough that the chin points clearly toward the ceiling.
When Not to Use It
If there’s any reason to suspect a neck or spinal injury, the head-tilt chin-lift is not the first choice. Think car crashes, falls from height, diving accidents, or any scenario involving trauma to the head or neck. Tilting the head back in these situations could worsen a spinal injury.
The alternative is the jaw-thrust maneuver. Instead of tilting the head, you position yourself at the top of the person’s head, place your palms on their temples, and use your fingers to push the lower jaw upward from behind. You’re lifting the jaw straight up without moving the neck at all. The goal is the same: pull the tongue forward and clear the airway, but without any neck extension.
That said, the AHA guidelines make an important point: if the jaw thrust doesn’t successfully open the airway, you should go ahead and use the head-tilt chin-lift even with a suspected spinal injury. The reasoning is straightforward. A person in cardiac arrest who can’t get oxygen will die. The importance of a clear airway outweighs the risk of spinal damage in that situation.
Adjustments for Infants and Small Children
Infants have proportionally larger heads than adults, which changes the mechanics. When a baby lies flat on their back, the large back of the skull naturally pushes the chin toward the chest, which can block the airway even before you do anything.
For infants, you want a “sniffing position” rather than a full head tilt. This means the head is in a neutral or very slightly extended position, as if the baby were sniffing the air. The tip of the nose should point straight toward the ceiling. You can place a thin rolled towel under the shoulders or neck to compensate for the large skull and bring the head into alignment. Avoid over-extending an infant’s neck, as their airways are much smaller and more flexible, and too much tilt can actually kink the airway shut.
The finger placement is the same principle (bony part of the chin, never the soft tissue), but use just one fingertip given the small size of the jaw.
Using the Chin Lift During CPR
During CPR, the chin lift comes into play every time you deliver rescue breaths. The standard sequence for adults is 30 chest compressions followed by 2 breaths. Before each set of breaths, you re-establish the head-tilt chin-lift to ensure the airway is open. If the chest doesn’t rise when you blow in, the most likely cause is an inadequate head tilt or chin lift. Reposition and try again.
You can maintain the head tilt with the hand on the forehead throughout compressions if you’re the only rescuer, or release and re-establish it between compression cycles. The key is that the airway must be open before each breath, or the air goes into the stomach instead of the lungs.