During cardiopulmonary resuscitation, if the victim vomits a small amount, can the airway be cleared by a head‑tilt maneuver without turning the patient, and how brief should the compression pause be?

Managing Small-Volume Vomiting During CPR with Head-Tilt Airway Clearance

If a victim vomits a small amount during CPR, you can use the head-tilt maneuver to clear the airway without turning the patient, but the pause must be kept under 10 seconds before immediately resuming chest compressions. 1

Immediate Management Steps

When vomiting occurs, briefly pause compressions, clear the airway quickly using a finger sweep or cloth, and resume compressions within 10 seconds. 1 The head tilt–chin lift maneuver is effective for opening the airway and can be used to facilitate clearance of small amounts of vomit 2. For minimal vomitus that does not require extensive clearing, this approach avoids the time-consuming process of log-rolling the patient.

Key Procedural Points

• Pause chest compressions only as long as absolutely necessary to clear visible vomitus from the airway 1
• Use the head tilt–chin lift maneuver to open the airway and improve visualization for rapid finger sweep or cloth removal 2
• Resume compressions immediately once the airway is cleared, targeting a pause of less than 10 seconds 2, 1
• Maintain a chest compression fraction of at least 60% throughout the resuscitation 1, 3

When to Turn the Patient vs. Use Head-Tilt Only

For small amounts of vomit, the head-tilt maneuver with quick finger sweep is sufficient and avoids the longer interruption required for turning. 1 However, if vomiting is profuse or cannot be adequately cleared with simple positioning, briefly turn the patient onto their side (log-roll if cervical spine injury is suspected), clear the airway, and immediately return to supine position for compressions 1.

Decision Algorithm

• Small volume, easily cleared: Head-tilt with finger sweep, pause <10 seconds 1
• Large volume or persistent: Log-roll to side, clear thoroughly, return to supine, pause <10 seconds total if possible 1
• Suspected spinal injury: Use manual cervical stabilization during any turning maneuver, not rigid immobilization devices 2

Critical Time Thresholds

Every 5-second increase in compression pause beyond 10 seconds significantly decreases survival. 3, 4 Specifically, preshock pauses longer than 10 seconds are associated with reduced survival to hospital discharge (OR 1.86 per additional 5 seconds, 95% CI 1.10-3.15) 1. This same principle applies to pauses for airway management.

Compression Interruption Limits

• Target pause duration: <10 seconds for all airway interventions 2, 1
• Maximum acceptable pause: 10 seconds, with strong evidence that longer pauses harm outcomes 1, 3
• Chest compression fraction goal: ≥60% of total resuscitation time 1, 3

Common Pitfalls to Avoid

Do not use abdominal thrusts or the Heimlich maneuver to clear vomitus during CPR—these are unnecessary and may cause injury 1. The Heimlich maneuver is reserved for foreign body obstruction in conscious or unconscious patients, not for clearing vomit during cardiac arrest 5, 6.

Do not check pulse or rhythm while managing vomiting—focus solely on rapid airway clearance and immediate resumption of compressions 1. Any assessment of circulation should wait until the next scheduled rhythm check at 2-minute intervals 2.

Do not perform prolonged or meticulous airway cleaning—clear only what is immediately obstructing ventilation, then resume compressions 1. Perfection in airway clearance is less important than minimizing the interruption in chest compressions.

Team Coordination Strategy

Assign one rescuer to manage airway clearance while another remains positioned and ready to restart compressions immediately, ensuring no delay in perfusion 1. This parallel preparation minimizes the total pause duration. The compressor should rotate every 2 minutes to prevent fatigue-related decline in compression quality 1, 3.

Incidence and Expectation

Approximately two-thirds of victims receiving rescue breathing during cardiac arrest will vomit, and about 86% of those requiring combined compressions and ventilations experience vomiting 1. Rescuers should anticipate this complication and be prepared to manage it efficiently without significantly interrupting CPR.