The head-tilt chin-lift is the standard maneuver used to open the airway in an unresponsive person. It works in most situations and is recommended by the American Heart Association for adult basic life support. The one major exception: if you suspect a head, neck, or spinal injury, use the jaw-thrust maneuver instead, which opens the airway without moving the neck.
Why the Airway Closes in the First Place
When someone loses consciousness, the muscles that normally keep the tongue in place relax. The tongue is anchored to the lower jaw, and the key muscle holding it forward is attached to the inside of the chin. When that muscle goes slack, gravity pulls the tongue backward and downward, where it presses against the soft palate and blocks the throat. This is the same basic mechanism behind snoring, but in an unresponsive person lying on their back, the obstruction can be complete. No air gets through at all.
Both the head-tilt chin-lift and the jaw-thrust work by physically repositioning the lower jaw so the tongue moves forward and away from the back of the throat. The difference is how much you move the neck to get there.
How to Perform the Head-Tilt Chin-Lift
This is the maneuver you’ll use in the vast majority of emergencies. With the person lying flat on their back:
- Place one hand on the forehead and gently press backward to tilt the head back.
- Place the fingertips of your other hand under the bony part of the chin and lift it upward. Use only the bony edge of the jaw, not the soft tissue underneath, because pressing into the soft tissue can actually compress the airway further.
Together, these two movements extend the neck and pull the lower jaw forward, clearing the tongue from the airway. The 2025 AHA guidelines confirm the head-tilt chin-lift as an effective technique, supported by radiological studies showing it reliably opens the upper airway passage.
When to Use the Jaw-Thrust Instead
If the person has a possible cervical spine injury, such as after a car crash, a fall from height, a diving accident, or any trauma to the head and neck, you should avoid tilting the head. Moving the neck in someone with an unstable spinal injury risks making the damage worse. The jaw-thrust maneuver opens the airway while keeping the neck in a neutral position.
To perform it, position yourself at the top of the person’s head. Place your palms on their temples and your fingers under the angles of the lower jaw on both sides. Lift the jaw upward and forward with your fingertips until the lower teeth rise above the upper teeth. This pulls the tongue forward just like the chin-lift does, but without bending the neck. Again, apply pressure only to bone, not soft tissue.
There is one important caveat. If the jaw-thrust alone doesn’t open the airway, you may still need to perform a head-tilt chin-lift even with a suspected spinal injury. The AHA guidelines are clear on this point: maintaining a patent airway and delivering oxygen take priority over the risk of spinal movement, especially during cardiac arrest.
Differences for Infants and Children
The basic principle is the same for children, but the degree of head tilt changes with age. Infants have proportionally larger heads and shorter necks, so their airways are best opened by placing the head in a neutral position, with the face pointing straight up rather than tilted back. Over-extending an infant’s neck can actually kink the soft, flexible airway and make things worse.
For older children, a slight head tilt (sometimes called the “sniffing position”) is appropriate, similar to the adult technique but with less extension. The younger the child, the less you tilt.
The Triple Airway Maneuver
Emergency medical professionals sometimes use a combined technique called the triple airway maneuver, which puts together three actions: head tilt, jaw thrust, and opening the mouth. After tilting the head and lifting the jaw, the rescuer uses both thumbs to open the mouth and visually check the airway. This is primarily a pre-hospital technique used by paramedics and is paired with devices like oral airways to keep the passage clear. For bystander first aid, the head-tilt chin-lift or jaw-thrust alone is sufficient.
How to Tell the Maneuver Worked
A few immediate signs tell you the airway is open. The most obvious is that you can hear and feel air moving. If the person is breathing on their own, you should see the chest rise and fall normally. Snoring in an unconscious person is a classic sign of a partially blocked airway, so if snoring stops after you reposition the jaw, you’ve likely cleared the obstruction.
Signs the airway is still blocked include noisy breathing, stridor (a high-pitched sound during inhalation), or a “see-saw” pattern where the chest pulls inward while the abdomen pushes outward. This paradoxical movement means the person is trying to breathe against an obstruction. If you see it, reposition and try again.
Keeping the Airway Open After the Maneuver
If the person is breathing on their own but remains unconscious, you’ll need to maintain that open airway until help arrives. Holding someone’s head in position for an extended period is tiring and impractical, so the recovery position is the standard solution.
Roll the person onto their side with the top leg bent at a right angle at the hip and knee to keep them stable. Tilt the head back gently to keep the airway open. This position lets gravity work in your favor: the tongue falls to the side rather than into the throat, and any fluids drain out of the mouth instead of pooling in the airway. If breathing stops at any point, roll the person onto their back and begin CPR.