Clinical Notes : Resuscitation

99. Choking - infant


Some countries have a survival rate following out of hospital cardiac arrest of 5% while other countries have a survival rate

as high as 30%. 

Countries with the best outcome have raised national cardiac arrest awareness and have embedded Chain of Survival in their emergency response protocols, so that more bystanders and first responders are able to deliver effective CPR.


In out-of-hospital cardiac arrest, ALS care (Advanced Life Support) is associated with increased ROSC (Return of Spontaneous Circulation), but is not associated with greater functional outcome than BLS care alone .


BLS choking infant under 1 year old



Assess for signs and symptoms of airway obstruction.

  • Partial airway obstruction

    • may result in stridor or a high-pitched audible noise during respiration

    • may allow for a productive cough or allow the infant to vocalise

  • Complete airway obstruction

    • the infant is unable to speak, cry, or provide any sounds of respiration

    • the adult/child may be confused, weak, obtunded, or cyanotic​




If partial airway obstruction:​​

  • Assess the airway, removing any visually present obstruction

  • Watch closely for progression to complete airway obstruction


If complete airway obstruction, and conscious infant:

  • Send someone to call the emergency response team

  • If alone:

    • immediately call the emergency response team

    • Provide Back Blows:

      • Position the infant :

        • Lay infant face and torso down on forearm (prone) with chest being supported by your palm and their head and neck by your fingers

        • Tilt the infant’s body at a 30 degree angle, head downward (trandelenburg)

        • Use your thigh or other object for support

        • Provide 5 rapid forceful blows using a flat palm on the infant’s back between the two scapula

  • ​Provide Chest Thrusts:

    • Re-position the infant :

      • Place your two fingers on the center of the infant’s sternum immediately below the nipple line

      • Provide 5 rapid compressions, with thrusts equaling 1/3 to 1/2 the total depth of the chest

      • Continue cycling back and forth between interventional back blows and chest thrusts until the obstruction is removed or until consciousness is lost

If infant becomes unconscious:

  • Immediately activate (or send someone to activate) EMS

  • Initiate CPR

  • After 2 minutes, if someone has not already done so, activate the emergency response system

  • Before attempting rescue breaths during normal CPR, assess the airway, removing any visually present obstruction

  • ​Simply looking into the mouth should not significantly increase the time needed to attempt the ventilations and proceed to the 30 chest compressions

  • Do not use a blind finger sweep in an attempt to remove an obstruction

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Guidelines for CPR & Emergency Cardiovascular Care

American Heart Association

Updated November 2017


Highlights of the 2015 American Heart Association Guidelines Updates for CPR and ECC



Resuscitation Council; UK

Adult basic life support and automated external defibrillation


ERC Guidelines 2015

European Resuscitation Council


Advanced vs. Basic Life Support in the Treatment of Out-of-Hospital Cardiopulmonary Arrest in the Resuscitation Outcomes Consortium.

Kurz et al

Resuscitation. 2018 Jul;128:132-137


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