When to Use the Jaw Thrust Maneuver for Rescue Breathing

In my article, "Hands Only CPR Has Not Eliminated the Need for Rescue Breathing," I explain that mouth to mouth resuscitation has been replaced with the safer and more efficient mouth to mask resuscitation. I also explain why hands only cardiopulmonary resuscitation (CPR) has not been elevated to or above the level of conventional CPR which calls for rescue breathing for someone in respiratory arrest. Mouth to mouth is still acceptable to most people who would ever have to perform rescue breathing on close friends and relatives. You would probably be aware of any contagious diseases they have and the relationship with them also tends to compel whatever action is necessary for them to have the best chances of survival.

The Jaw Thrust Maneuver and C Spine Injury During Rescue Breathing

As an emergency medical technician (EMT), I was required to receive conventional CPR training at the health care provider level which always includes learning how to perform rescue breathing in cases of respiratory arrest. Therefore, I was trained to operate an automated external defibrillator (AED) and to give care not only to adults, but also to children and infants. I know that the things covered in CPR training for laypeople vary, which might explain why there's very little mention of a technique called the jaw thrust maneuver when speaking of mouth to mouth or mouth to mask resuscitation.

A heart attack is by no means the only medical emergency that can lead to someone going into cardiac and/or respiratory arrest. Any sort of trauma to the chest such as wounds caused by gunshot, a stabbing, a severe fall, and an accident or act of violence that crushes the chest cavity can create a threat to someone's breathing. The problem with these types of injuries is that they can also cause injury to the spinal cord which is divided into five sections. The cervical spine, commonly referred to as the "c spine" among health care providers, is the neck. Injuries to the c spine can lead to paralysis and they can be life-threatening, particularly if they are high in the cervical area as nerves that control the diaphragm, a muscle involved in breathing, are located there.

The usual instructions given for opening the airway are to perform what's known as the head tilt chin lift maneuver. However, when there is a degree of suspicion that someone in respiratory arrest has suffered a spinal cord injury, opening the airway should first be attempted with the jaw thrust maneuver. This maneuver avoids tilting the head and further aggravating a possible spinal cord injury.

How to Perform the Jaw Thrust Maneuver

The following steps are the recommended procedure to open the airway of an unconscious victim in respiratory arrest who might have suffered injury to the spinal cord. They should be followed after carefully placing the individual in the supine position (face up). The victim should be moved as one single unit, keeping the head, neck and spine aligned.

1. Kneeling at the top of the person's head, reach forward and place one hand on each side of the lower jaw; do your best to immobilize the head using your forearms.

2. Use your index fingers to push forward on the angles of the lower jaw to open the mouth; it might be necessary to use your thumb to withdraw the lower lip to maintain the mouth open. Begin rescue breathing if the individual is in respiratory arrest. This applies whether you perform mouth to mouth or mouth to mask resuscitation.

During my training, I remember concentrating so heavily on learning how not to further injure a patient during rescue breathing who might have suffered a spinal cord injury that I didn't know how to answer when my trainer asked what an EMT or medic should do if after a couple of attempts to do rescue breathing, the patient is still not being ventilated. He reminded his class of what is known as the ABC's of emergency medicine--airway, breathing, and circulation. His words were, "Don't let a patient in respiratory arrest die just because you suspect he might have a spinal cord injury. Quickly revert back to the head tilt chin lift procedure if the airway can't be opened with the jaw thrust maneuver." He wanted us to remember that the spinal cord injury was a "maybe" and could possibly be fixed by a surgeon; going too long without breathing, however, will cause the brain to die, something that no man can fix.

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Certified by the National Registry of Emergency Medical Technicians (NREMT), EMT state license, professional experience