ACLS Provider: Course

Jaw-Thrust Maneuver

The jaw-thrust maneuver is a critical airway-opening technique used when there is concern for cervical spine injury. Unlike the head-tilt/chin-lift, the jaw-thrust avoids neck movement, making it the preferred technique for trauma patients. It allows rescuers to lift the jaw forward and relieve airway obstruction without compromising spinal alignment.

Indications

• Unresponsive patient requiring airway support.
• Suspected cervical spine injury (e.g., trauma from falls, motor vehicle collisions, or head injury).
• Situations where head movement should be avoided during airway management.

Contraindications

• Conscious or semi-conscious patients (painful and distressing when awake).
• Severe mandibular or facial trauma, where the maneuver may be ineffective or harmful.

Technique

1. Place the patient supine on a firm, flat surface.
2. Position yourself at the top of the patient’s head.
3. Place your index and middle fingers behind the angles of the mandible.
4. Using firm, upward pressure, lift the jaw forward to displace the tongue and open the airway.
5. Avoid head tilt or neck movement throughout the maneuver.
6. If ventilating with a bag-valve mask (BVM), a second rescuer may be needed to maintain an effective seal while the jaw is held forward.

Common Errors

• Tilting the head back: This can compromise spinal precautions. Maintain a neutral head position at all times.
• Insufficient jaw lift: Failing to move the mandible far enough forward may leave the airway partially obstructed.
• Fatigue during prolonged use: If jaw-thrust must be sustained, switch rescuers as needed or consider advanced airway placement.

Key Considerations

• The jaw-thrust should be your go-to maneuver when spinal injury cannot be ruled out.
• Effective use may require practice—it demands more strength and coordination than the head-tilt/chin-lift.
• If ineffective alone, consider adjuncts like an oropharyngeal (OPA) or nasopharyngeal airway (NPA) to maintain patency.