CPR: Is it the Best Thing to Do When Choking?

Here's a question that trips people up in emergencies: if someone's choking, do you jump straight to CPR?

Short answer: No. CPR can play a critical role - just not in the way most people think.

Let's clear up the confusion around when CPR comes into play during a choking emergency, and why the technique changes when someone's airway is blocked.

Quick Answer:

• CPR is NOT the first response to conscious choking - back blows and chest (or abdominal) thrusts, and airway clearance devices (if available) come first.
• CPR can become essential when a choking person loses consciousness, and all other methods have failed.
• Modified CPR for choking includes a crucial step: checking the mouth for visible objects after each compression cycle.
• Chest compressions themselves can help dislodge the obstruction; however the only studies conducted have been on already deceased patients when the structures of the airways have changed. 
• Never do blind finger sweeps deeper than the mouth - only remove objects you can actually see.

So, When Does CPR Actually Come In?

Think of choking management in two phases: conscious and unconscious.

• Phase 1: They're still conscious.

While someone can still cough, respond, or show signs of awareness, CPR isn't your move. You're focused on clearing that airway with back blows and chest (abdominal) thrusts. These should be alternated, i.e. five of each until the object comes out, fails after two rounds, or they lose consciousness.

If they're coughing forcefully, even if it sounds awful, step back. A strong cough generates more pressure than any first aid technique you can perform. Stay close, monitor them, but let their body do its job.

• Phase 2: They become unconscious.

This is where everything changes. The moment someone choking loses consciousness, you're switching gears, and the benefit of an airway clearance device is vital. Once they're unresponsive, their muscles relax, and you've got two problems now: a blocked airway AND failing circulation. Standard first aid won't work anymore - they need compressions to keep blood moving to their brain. In this case, if you do not have access to an airway clearance device, e.g. LifeVac, then the only option is CPR, although this has only demonstrated some limited success on deceased people. 

What Makes Choking CPR Different?

Here's the bit that confuses people: CPR for a choking victim isn't standard CPR. There's one critical modification that makes all the difference.

After every 30 compressions, before you attempt ventilations (sometimes called “rescue breaths”), open their mouth and look for the object. If you see something that's loose, remove it with your finger. If you don't see anything, don't go fishing around - that's called a blind finger sweep, and it can push the obstruction deeper.

This "look and remove" step happens after each compression cycle. The compressions themselves create pressure changes in the chest that can shift the object from the throat into the mouth, where you can reach it. That's why you keep checking.

The cycle looks like this:

1. 30 chest compressions (hard and fast, 100-120 per minute, 5-6cm deep)
2. Open mouth, look for object
3. Remove object if visible
4. Attempt 2 ventilations (“rescue breaths”)
5. If breaths don't go in (chest doesn't rise), repeat from step 1

You keep this going until the object comes out, they start breathing on their own, or paramedics take over.

Obviously, with the obstruction still in place, the effectiveness of ventilations “rescue breaths” will be diminished and largely ineffective. 

Why Can't You Just Do Regular CPR?

Standard CPR assumes the airway is clear. You position the head, give compressions, deliver breaths, and focus on restarting the heart or maintaining circulation until help arrives.

But in choking CPR, the airway might still be blocked. If you attempt ventilations (“rescue breaths”) without clearing the obstruction, you're just blowing air against a wall. It won't reach the lungs. Worse, you're wasting precious seconds that could be spent on compressions that might dislodge the object.

That's why the mouth check is important. Every compression cycle might shift that piece of steak or lolly closer to where you can grab it. Miss the check, and you've missed your opportunity.

The Mouth Check Protocol: What You Need to Know

Let's be specific about this because technique matters.

After your 30 compressions, use your thumb and index finger on the chin to open the person's mouth. Look inside. You're searching for anything that doesn't belong: food, objects, whatever caused the initial choking.

If you see something and it looks loose, use your finger to hook it out. Be deliberate but careful - you don't want to push it further back.

If you don't see anything, don't panic and don't start sweeping your finger around blindly. Go straight to your rescue breaths. Tilt the head back, lift the chin, seal your mouth over theirs (ideally with a barrier mask), and attempt two breaths. Watch for chest rise.

If the chest doesn't rise, the airway's still blocked. Back to compressions. The cycle continues. Of course, an airway clearance device can still be used in these circumstances, and you should not wait for CPR to fail before using an airway clearance device, like the genuine LifeVac as it is highly unlikely at this stage that CPR will be effective.

What About Backup Options?

Traditional choking first aid - back blows and chest (or abdominal) thrusts for conscious victims, modified CPR for unconscious ones - forms your foundation. But what happens when these standard techniques fail?

This is where first aid choking devices enter the picture. These suction-based tools create negative pressure to pull obstructions out when initial first aid techniques haven't worked, i.e., back blows and chest (or abdominal) thrusts, both performed from behind the person. They're particularly valuable in situations where the person is unconscious, pregnant, or when you've cycled through first aid repeatedly without success.

While child or adult choking devices should not replace CPR training, they're becoming recognised as an additional tool in the choking response toolkit - especially for families caring for high-risk individuals or in settings where choking incidents are more common.

Conscious vs Unconscious Response

CPR isn't the first move when someone's choking - but it becomes the essential move once they lose consciousness in the absence of a choking device.

The key is recognising that transition point. While they're conscious and struggling, you're focused on back blows and chest thrusts. The second they go limp, you're lowering them safely to the ground and starting modified CPR with that crucial mouth check after each compression cycle.

You need to know exactly when CPR comes into play, how it differs for choking victims, and what that mouth check actually looks like in practice. That knowledge and the right equipment - that's what saves lives.