To open an unconscious person’s airway, place one hand on their forehead, gently tilt the head back, and lift the chin upward with the fingers of your other hand. This two-step technique, called the head-tilt/chin-lift, is the standard method recommended by the American Heart Association for basic life support. It works by pulling the structures at the back of the throat forward and away from the airway, clearing the path for air to flow.
Why an Unconscious Person’s Airway Closes
When someone loses consciousness, the muscles that normally hold the airway open go slack. Research using bronchoscopes to observe the airways of deeply unconscious patients found that the epiglottis, a small flap of tissue at the base of the throat, is the main structure that falls back and blocks airflow. The tongue can contribute, but the epiglottis is the primary culprit. Any maneuver that pulls the hyoid bone (a small horseshoe-shaped bone in the neck connected to the tongue and epiglottis) forward will clear the obstruction in most cases. That’s exactly what tilting the head back and lifting the chin accomplishes.
Head-Tilt/Chin-Lift Step by Step
This is the go-to technique when there’s no reason to suspect a neck or spinal injury.
- Step 1: Place one hand on the person’s forehead and apply gentle, steady pressure to tilt the head backward.
- Step 2: Place the fingertips of your other hand under the bony part of the chin and lift upward.
One critical detail: keep your fingers on the bone of the chin only. Pressing into the soft tissue underneath the jaw can compress the airway from the outside and make the obstruction worse. You’re essentially creating a straight line from the mouth down to the lungs by extending the neck and moving the jaw forward.
When to Use the Jaw-Thrust Instead
If the person may have a spinal injury, such as after a fall, car crash, or diving accident, you should avoid tilting the head back. Moving the neck could worsen spinal cord damage. The alternative is the jaw-thrust maneuver, which 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 jawbone on both sides. Then push the lower jaw upward until the bottom teeth sit higher than the upper teeth. As with the chin lift, only apply pressure to bone, never soft tissue.
There’s an important caveat from the AHA’s 2020 guidelines: if the jaw thrust doesn’t successfully open the airway, you should go ahead and use the head-tilt/chin-lift even when spinal injury is possible. In a cardiac arrest situation, an open airway is more immediately critical than the risk of spinal movement.
How to Confirm the Airway Is Open
Once you’ve performed the maneuver, you need to check that it actually worked. The simplest test: if the person is breathing spontaneously, you should be able to see the chest rise and fall. You can also hold the back of your hand near the person’s mouth and nose to feel airflow. A wet hand makes faint breaths easier to detect. If the person can vocalize or make sounds, the airway is open.
If you don’t see chest movement or feel breath, reposition and try again. Sometimes a slight adjustment in head angle makes the difference. If repositioning still doesn’t work, consider that something may be physically blocking the airway.
Clearing a Blocked Airway
If you can see a foreign object in the person’s mouth, remove it. But never sweep a finger blindly into the throat. Blind finger sweeps can push an object deeper, potentially lodging it at the entrance to the windpipe and making the situation worse. Only remove what you can clearly see.
For a conscious person who is choking, abdominal thrusts (the Heimlich maneuver) remain the standard approach. The airway-opening techniques described here are for unconscious individuals who aren’t protecting their own airway.
Opening an Infant’s Airway
Babies and young infants require a different approach because their anatomy is proportionally different. A baby’s head is large relative to its body, which means simply laying an infant flat on a surface can flex the neck forward and close the airway.
For newborns, resuscitation guidelines recommend a “sniffing position,” where the neck is slightly flexed forward but the upper part of the spine is gently extended. A small rolled towel under the neck or shoulders can help achieve this. Research using MRI data found that infants from birth to four months had a greater than 95% chance of a clear airway when the head was positioned at a slight extension, corresponding to a head-tilt angle of roughly 144 to 150 degrees. That translates to just a gentle tip backward, far less extension than you’d use on an adult. Overdoing the tilt on an infant can actually kink the airway shut because their trachea is soft and flexible.
Keeping the Airway Open After You’ve Cleared It
If the person is unconscious but breathing on their own and doesn’t need CPR, the recovery position prevents the airway from closing again. It also lets fluids like vomit, blood, or mucus drain out of the mouth rather than pooling in the throat.
Starting with the person flat on their back, move their closest arm up into an L-shape beside their head, as if they’re waving. Take their far hand and bring it across their body. Then roll them toward you onto their side, positioning them so their face tilts slightly downward and their head rests a bit lower than their stomach. This angle uses gravity to keep the airway clear and allows fluids to drain naturally.
If You Need to Give Rescue Breaths
Opening the airway is the essential first step before delivering rescue breaths during CPR. Current AHA guidelines prioritize starting chest compressions first, then opening the airway for ventilation. The recommended ratio is 30 compressions to 2 breaths for a single rescuer.
Each breath should be just enough to make the chest visibly rise, roughly 500 to 600 milliliters of air. That’s a normal, steady breath, not a forceful one. Blowing too hard or too fast pushes air into the stomach instead of the lungs, which can cause vomiting and make everything harder. Maintain the head-tilt/chin-lift position throughout rescue breathing to keep the airway open between compressions.