Choking is a medical emergency that can become fatal in a matter of minutes, particularly when an adult becomes unresponsive. At this stage, the airway is fully blocked, preventing oxygen from reaching the lungs and causing rapid deterioration. Protective reflexes, such as coughing and gagging, cease, making it impossible for the victim to clear the obstruction on their own. Immediate Cardiopulmonary Resuscitation (CPR) is critical to prevent cardiac arrest and preserve vital organ function.
Unlike standard CPR, which focuses on maintaining circulation in victims of cardiac arrest, CPR for an unresponsive choking adult requires special modifications to address both the airway blockage and blood flow. Traditional methods such as back blows or abdominal thrusts are no longer safe or effective. Instead, rescuers must perform chest compressions immediately while periodically checking the mouth for visible obstructions and attempting rescue breaths in a carefully structured sequence. This dual focus ensures oxygen delivery while maximizing the chances of dislodging the blockage.
This blog breaks down how CPR is adapted for an adult choking emergency, why these modifications are necessary, and the key actions rescuers should prioritize to save a life.
How Does CPR Change When an Adult Choking Victim Becomes Unresponsive?
When an adult choking victim becomes unresponsive, CPR must be modified to address both the blocked airway and the need to maintain blood flow. In this situation, rescuers focus primarily on chest compressions, which help circulate blood while generating internal pressure that may dislodge the obstruction. Unlike standard CPR, special steps are taken to check the airway and provide rescue breaths effectively.
Here are the key ways CPR differs for an unresponsive adult choking victim:
1. Chest Compression is Started Immediately
In standard CPR, rescuers typically check for breathing and a pulse before starting chest compressions. In a choking emergency, however, once an adult victim becomes unresponsive, chest compressions should begin immediately without checking for breathing or a pulse. This is critical because the airway is blocked, preventing oxygen from reaching the lungs and rapidly increasing the risk of cardiac arrest. Chest compressions help maintain blood flow to vital organs and create internal pressure within the chest that may help loosen or expel the airway obstruction.
2. Mouth is Checked for an Object Between Compressions
One key difference between standard CPR and CPR for an unresponsive choking adult is the routine inspection of the mouth. During CPR for a choking victim, the rescuer should open the mouth after each set of 30 chest compressions and look carefully for any visible obstruction. If an object is clearly seen, it should be removed gently and carefully to avoid pushing it deeper into the airway. Blind finger sweeps must never be performed, as they can worsen the obstruction and cause further airway blockage.
In contrast, standard CPR does not involve routine airway checks between compression cycles. This makes mouth inspections a unique and essential step in choking-related CPR.
3. Modified Ventilations
After completing a set of 30 chest compressions and checking the mouth for any visible obstruction, rescuers should attempt 2 rescue breaths. Rescue breaths should be given regardless of whether an object was removed or if no object is visible, as oxygen delivery remains critical.
If the breaths do not go in, the rescuer should reposition the head and attempt the second breath. If the airway is still blocked and the chest does not rise, chest compressions should be resumed immediately. This cycle of compressions and ventilations helps maintain circulation while creating pressure that may dislodge the obstruction.
4. Continued Cycles Until the Airway Clears
CPR for an unresponsive choking adult is performed in repeated cycles of 30 chest compressions, mouth checks, and 2 rescue breaths until the airway is cleared or emergency responders arrive. Multiple cycles may be necessary because the obstruction may not be dislodged immediately. Rescuers should continue compressions and airway checks consistently, maintaining circulation while attempting to restore airflow. This approach differs from standard CPR, where ventilations usually succeed after the first attempt; in choking-related CPR, persistence is key to removing the blockage and saving the victim’s life.
How to Perform CPR in an Unresponsive Adult Choking Victim?
Performing CPR on an unresponsive adult choking victim requires specific modifications from standard CPR, focusing on immediate chest compressions to maintain blood flow while also attempting to clear the blocked airway.
Here are the step-by-step instructions for performing CPR on an unresponsive adult who is choking:
1. Ensure Scene Safety
Before approaching the victim, make sure the environment is safe for both the rescuer and the patient. Remove any hazards that could cause further injury.
2. Call 911
You should have called 911 while the person was still conscious and choking. If this wasn’t done, call emergency services immediately once the victim becomes unresponsive, or ensure someone else makes the call. Prompt professional help is critical because unresponsive choking victims can deteriorate quickly, and trained medical personnel may be required to remove the obstruction safely.
3. Begin Chest Compressions Immediately
After calling 911, start chest compressions immediately without checking for pulse or breathing. Place the heel of your hand on the center of the chest and compress at a rate of 100-120 per minute.
4. Check the Mouth for Obstructions
Once you complete 30 sets of compressions, open the mouth and look for any visible objects. If an object is seen, remove it carefully. Never perform a blind finger sweep, as this can push the blockage deeper. Regular mouth checks are essential in choking-related CPR.
5. Give 2 Rescue Breaths
After you check for obstructions, attempt 2 rescue breaths, even if no obstruction was seen or removed. If the chest does not rise after the first breath, reposition the head and attempt the second breath. If the chest still does not rise, resume compressions immediately. This approach ensures that oxygen is delivered whenever possible while maintaining circulation, and it follows the modified CPR protocol for unresponsive choking victims.
6. Repeat CPR Cycles
Continue the cycle of 30 compressions, mouth checks, and 2 rescue breaths until the airway is cleared, the victim starts breathing, or trained emergency help arrives. Multiple cycles may be required because the obstruction may not be removed immediately.
7. Use an AED If Available
If an automated external defibrillator (AED) is available, apply it as soon as possible and follow the voice prompts. Continue CPR while the AED analyzes the heart rhythm and delivers shocks if advised.
What Should You Do After CPR Succeeds or Fails in an Unresponsive Adult Choking Victim?
After performing CPR on an unresponsive adult choking victim, the next steps are critical, whether the victim regains consciousness or not. Knowing what to do in both scenarios ensures continued care, maintains airway safety, and maximizes the chances of survival until professional medical help arrives.
Here are the key actions to take after CPR succeeds or fails:
If CPR Succeeds
- Place the victim in the recovery position (on their side) to keep the airway open and prevent choking if vomiting occurs.
- Continually monitor their breathing and pulse, and be prepared to resume CPR immediately if conditions worsen.
- Keep the victim calm and still, and do not give food or drink.
- Reassure them until emergency medical personnel arrive.
- Early medical evaluation is crucial, even if the person seems fully recovered, as complications from choking or oxygen deprivation may still arise.
If CPR Fails
- Continue cycles of compressions and rescue breaths as long as you are physically able or until professional help arrives.
- Use an AED as soon as it is available, following the device prompts.
- Do not stop prematurely unless the scene becomes unsafe.
What Common CPR Mistakes Should Be Avoided in an Adult Choking Emergency?
Even small errors during CPR on an unresponsive adult choking victim can greatly reduce the chances of survival. Being aware of these common mistakes helps rescuers avoid them and act confidently under pressure.
Here are some of the most common mistakes rescuers make:
1. Performing Abdominal Thrusts on an Unconscious Person
Once the victim is unresponsive, abdominal thrusts are not safe or effective. They can cause injury and do not help dislodge the object in this situation. Chest compressions are the correct approach.
2. Attempting Blind Finger Sweeps
Never try to remove an object you cannot see. Blind sweeps can push the obstruction deeper into the airway, making the situation worse. Only remove objects that are clearly visible.
3. Delaying the 911 Call
Time is critical. Delaying professional help reduces survival chances. Always call 911 immediately, or ensure someone else calls while you begin CPR.
4. Late Initiation of Chest Compressions
Once the adult becomes unresponsive, waiting to check for a pulse or breathing can waste critical seconds. Start compressions immediately after calling 911.
5. Neglecting Mouth Checks Between Compressions
Regular inspections of the mouth after every 30 compressions are essential. Skipping this step reduces the chance of clearing the obstruction.
6. Stopping CPR Prematurely
Continue CPR until emergency help arrives, the victim begins breathing, or you are physically unable to continue. Stopping too soon can be fatal.
Be Prepared to Act: Life-Saving CPR for Adult Choking Situations
CPR for an unresponsive adult choking victim differs from standard CPR because the technique is modified to address both airway blockage and circulation simultaneously. It begins with chest compressions, and after every set of 30 compressions, the mouth should be checked for visible obstructions before giving 2 rescue breaths. This cycle is repeated continuously until emergency help arrives or the person shows clear signs of life. It is also crucial to avoid common mistakes, such as blind finger sweeps, delaying compressions, or stopping CPR too soon, as these errors can significantly reduce the chances of survival.
Knowing the steps is essential, but practice and hands-on experience are what prepare you to act in a real emergency. That’s why CPR VAM, an American Heart Association (AHA) certified training center, offers expert-led CPR courses like BLS, ACLS, and PALS that focus on real-life scenarios, including unresponsive choking adults. By enrolling, you’ll gain practical skills, reinforce proper technique, and be ready to respond effectively when every second counts.
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