What happens when a patient vomits black material during cardiopulmonary resuscitation (CPR) chest compressions?

Black Material from Patient's Mouth During CPR

The black material coming out of the patient's mouth during chest compressions is most likely vomitus (gastric contents), which is an extremely common occurrence during resuscitation—occurring in two-thirds of patients receiving rescue breathing and 86% of those requiring compressions and ventilations. 1

Why Vomiting Occurs During CPR

• Chest compressions increase intrathoracic and intra-abdominal pressure, which can force gastric contents upward through the esophagus and out of the mouth 1
• The black or dark brown color typically indicates partially digested blood (coffee-ground appearance) or old gastric contents, suggesting either upper gastrointestinal bleeding or prolonged gastric stasis 1
• During cardiac arrest, the lower esophageal sphincter loses tone, making regurgitation more likely when external pressure is applied to the chest and abdomen 1

Immediate Management Steps

When vomiting occurs during resuscitation, turn the victim to the side and remove the vomitus using your finger, a cloth, or suction. 1 This is the American Heart Association's direct recommendation for managing this complication.

Critical Actions:

• Do NOT stop chest compressions for more than 10 seconds to manage the vomitus—minimize interruptions as much as possible 1
• If spinal cord injury is suspected, logroll the patient so that the head, neck, and torso are turned as a unit to protect the cervical spine 1
• Clear the airway quickly using finger sweeps, cloth, or suction as available 1
• Resume compressions immediately after clearing the airway 1
• Monitor for aspiration risk—vomiting during resuscitation can lead to aspiration pneumonia and decreased oxygen saturation 2

What NOT to Do

• Do NOT perform abdominal thrusts or the Heimlich maneuver to try to clear vomitus—these are unnecessary and potentially dangerous during CPR 1
• Do NOT perform blind finger sweeps as they may push material farther into the pharynx 1
• Do NOT delay resumption of compressions beyond what is absolutely necessary to clear the airway 1

Clinical Significance of Black Vomitus

The black color warrants attention once ROSC is achieved:

• Coffee-ground emesis suggests upper GI bleeding that may have preceded or contributed to the cardiac arrest 1
• This finding should prompt investigation for peptic ulcer disease, gastritis, esophageal varices, or other sources of upper GI hemorrhage once the patient is stabilized 1
• Aspiration of this material increases risk of chemical pneumonitis and subsequent pneumonia 2

Prevention of Complications

• Maintain continuous airway monitoring throughout resuscitation efforts 2
• Have suction equipment immediately available at all resuscitation attempts 1
• Position the patient appropriately if vomiting recurs—lateral positioning when possible without compromising CPR quality 1
• Consider advanced airway placement if recurrent vomiting interferes with ventilation, though this should not delay chest compressions 1

Key Pitfall to Avoid

The most common error is stopping compressions for too long to manage vomitus. Chest compressions are the highest priority intervention in cardiac arrest, and interruptions directly correlate with decreased survival. 1 Clear the airway as quickly as possible and immediately resume high-quality compressions at a rate of at least 100/minute with depth of at least 2 inches. 1