Intervention for Choking in an Unconscious Dog: XXT – eXternal eXtraction Technique

December 12, 2018 (published)

Current treatment for choking (airway obstruction) in dogs includes performing the Heimlich maneuver (abdominal thrusts), removal with forceps, performing a finger sweep (in an unconscious patient), or rescue breathing. Advanced airway techniques (surgical cricothyrotomy) may be an option in a veterinary clinic, or with adequate prehospital training in the field. The eXternal eXtraction Technique (XXT) is a safer, more effective treatment/intervention for choking in an unconscious dog. This technique is indicated for full airway obstruction of a ball or similar object in an unconscious patient.

Click on Image below to see Video Procedure:

Fortunately, true choking (complete airway obstruction) is uncommon. However the authors are aware of multiple reported cases of fatal airway obstructions during training or play sessions. There are also reports of pet owners suffering injury including loss of fingers attempting to retrieve an object from the back of a dog’s throat. Working dogs are particularly high risk due to their high drive and intense focus for reward.

XXT is indicated for:

  • Full airway obstruction
  • Ball or similar hazard
  • Unconscious patient


  1. Place the unconscious dog on his back. Brace the back against the floor. Straddle the dog, adjusting yourself based on the size of the dog. Position the head in “in-line position” with the airway parallel to the floor.

    Photo courtesy of Dr. Robin Van Metre
  2. Identify landmarks – trachea (ringed tube), ball location, mandible (v-shaped jaw bone). Make an open diamond shape with your hands. Place your thumbs on either side of the trachea below the ball or object. Grip the “V” of the jaw using lip/cheek to protect fingers.
    Photo courtesy of Dr. Robin Van Metre
  3. Push with a J-stroke down and out against the ball until it ejects from the mouth.

    Photo courtesy of Dr. Robin Van Metre
  4. Provide two rescue breaths.
  5. If patient does not respond, begin CPR.

Choking on a ball or similar object may be avoided by adequate safety precautions. The size and shape of toys and ball rewards should be evaluated prior to offering them to your pet. Balls and Kongs should be checked for damage, cracks, etc. Supervision is recommended for balls, Kongs, and chews. See “Play it SSSAFE” to mitigate risk. (Jo-Anne Brenner EMT-I, EMT, K9 MEDIC, KaLee Pasek DVM, K9 MEDIC Education Director, Police K9 Magazine)

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