Debunking a Life-Threatening Myth: "Tongue Swallowing Prevention" Maneuvers Delay CPR and Might Contribute to Brain Injury or Death for Collapsed Athletes

Despite widespread public health efforts, the dangerous myth of "prevention of tongue swallowing" continues to persist during cardiopulmonary resuscitation (CPR). New research in the Canadian Journal of Cardiology, published by Elsevier, exposes the mainstream and social media’s detrimental role in perpetuating this misconception, which often leads to critical delays in proper CPR for collapsed athletes.

Concern about “tongue swallowing” leads resuscitators to waste valuable time trying to remove the tongue from the airway path, rather than immediately initiating essential CPR procedures. The findings from this analysis underscore an urgent need for global public health campaigns to correct CPR myths and emphasize the importance of immediate chest compressions. The study systematically analyzed 45 cases of athletes collapsing during sports events (1990–2024) that were caught on video or documented online, focusing on initial resuscitation actions and corresponding media coverage.

Commenting on the main findings of the analysis, lead investigator of the article "The Myth of “Tongue Swallowing” Delays Cardiopulmonary Resuscitation of Athletes With Cardiac Arrest, Yet It Is Often Perpetuated by the Media" Dana Viskin, MD, Department of Cardiology, Tel Aviv Sourasky Medical Center and School of Medicine, Tel Aviv University, says, “Our analysis showed that in 84% of cases where the initial response was visible, inappropriate maneuvers to ‘prevent tongue swallowing’ were performed before proper CPR. These incorrect actions were significantly associated with poor outcomes: 67% of those receiving such maneuvers died or had severe brain injury, compared to 0% when CPR was the first response.”

Media analysis revealed that nearly half (48%) of high-exposure news articles explicitly used the term “tongue swallowing,” with most praising the lay responder for their actions. In articles describing sudden cardiac arrest (SCA) cases, 77% referenced “tongue swallowing” without acknowledging its inappropriateness as a response to SCA, yet only 23% explicitly criticized the intervention.

“Given that some SCA patients, particularly young males with shockable arrest rhythms, may exhibit seizure-like activity at onset – a pattern frequently observed in sports-related SCA – it is understandable how this myth may have carried into the public response to athletic SCA, despite the absence of clinical guideline support for such an intervention,” points out the author of the accompanying editorial "Countering Misinformation in the Response to Sudden Cardiac Arrest in Athletes" Nicholas Grubic, MSc, Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto. “Furthermore, signs such as cyanosis and agonal respirations can be mistaken for choking, often prompting bystanders to prioritize airway inspection over initiating CPR. Recent qualitative research has confirmed that such misinterpretations can delay or even interrupt life-saving interventions. Although promoting CPR and automated external defibrillator (AED) knowledge remains a cornerstone of SCA education, teaching the public to recognize the early signs of an arrest is equally critical, as every second without action drastically reduces the chance of survival.”

This research is especially important now, as public CPR education becomes increasingly vital with widespread media exposure to cardiac arrests in sports.

"Our study highlights the dangerous and persistent misconception of ‘tongue swallowing prevention,’ which can delay the initiation of life-saving chest compressions. These delays may cost lives, and yet the media often praise such misguided actions as heroic. We urgently need to re-educate the public and the media and reframe the narrative around CPR, especially in sports," emphasizes Dr. Viskin.

Mr. Grubic adds in conclusion, “Coordinated, evidence-informed communication strategies are essential to counter misinformation and support public understanding, particularly in high-stakes situations such as the response to SCA in athletes. Our public capacity to save lives should not be impeded by misinformed voices – now is the time for the academic, healthcare, and media sectors to join forces and build a healthier information environment for all. Responding to SCA is a team sport that starts with proper education to ensure that everyone is ready to step in, stay focused, and act. Although the prize is not a trophy, it is something much more valuable.”

Notes for editors

The article is “The Myth of “Tongue Swallowing” Delays Cardiopulmonary Resuscitation of Athletes With Cardiac Arrest, Yet It Is Often Perpetuated by the Media,” by Dana Viskin, MD, Ido Avivi, MD, Ofer Havakuk, MD, Sapir Sadon, BSc, Yan Topilsky, MD, Shmuel Banai, MD, and Ehud Chorin, MD (https://doi.org/10.1016/j.cjca.2025.06.002). The article is openly available at https://onlinecjc.ca/article/S0828-282X(25)00384-8/fulltext.

Journalists wishing to speak to the authors should contact Dana Viskin, MD, at +1 507 405 6117 or [email protected].

The editorial commentary is "Countering Misinformation in the Response to Sudden Cardiac Arrest in Athletes," by Nicholas Grubic, MSc, James McKinney, MD, MSc, Nathaniel Moulson, MD, and Amer M. Johri, MD, MS, FASE (https://doi.org/10.1016/j.cjca.2025.07.001). The article is openly available for 30 days at https://onlinecjc.ca/article/S0828-282X(25)00534-3/fulltext.

Journalists wishing to speak to the authors should contact Nicholas Grubic at [email protected].

Both articles appear online in the Canadian Journal of Cardiology, published by Elsevier.

Full text of the articles is also available to credentialed journalists upon request. Contact Astrid Engelen at +31 6 14395474 or [email protected] to request a PDF of the article or more information.

About the Canadian Journal of Cardiology

The Canadian Journal of Cardiology (CJC) is an international, peer-reviewed journal that disseminates new knowledge in cardiology and cardiovascular science. It is the preferred Canadian cardiovascular medicine peer-reviewed publication and is an official journal of the Canadian Cardiovascular Society(CCS). The CJC publishes original reports of clinical and basic research relevant to cardiovascular medicine, as well as practice guidelines, editorials, review articles, and case reports. www.onlinecjc.ca

About the Editor-in-Chief

Editor-in-Chief Stanley Nattel, MD, is Paul-David Chair in Cardiovascular Electrophysiology and Professor of Medicine at the University of Montreal and Director of the Electrophysiology Research Program at the Montreal Heart Institute Research Center.

About the Canadian Cardiovascular Society (CCS)

The CCS is the national voice for cardiovascular clinicians and scientists, representing more than 2,300 cardiologists, cardiac surgeons and other heart health specialists across Canada. We advance heart health for all by setting standards for excellence in heart health and care, building the knowledge and expertise of the heart team, and influencing policy and advocating for the heart health of all Canadians. For further information on the CCS visit www.ccs.ca/en.

About Elsevier

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