What Is the Heimlich Maneuver?

The Heimlich maneuver — formally called abdominal thrusts — is an emergency procedure used to dislodge a foreign object (typically food) blocking a person's airway. Choking is the fourth leading cause of accidental death in the United States, claiming approximately 5,000 lives annually. The Heimlich maneuver, developed by thoracic surgeon Dr. Henry Heimlich in 1974, has saved hundreds of thousands of lives since its introduction. Understanding when and how to perform it — including critical variations for different populations — is among the most essential emergency skills anyone can learn.

How Choking Occurs

Choking occurs when a foreign object — most commonly food, but also toys, coins, or other objects — partially or completely blocks the trachea (windpipe). The trachea and esophagus share the same entrance (the pharynx), and swallowing normally directs food to the esophagus while the epiglottis — a small flap — prevents food from entering the trachea. When this coordination fails (while talking, laughing, or eating too quickly), food or another object can enter the airway.

Partial Obstruction (Effective Cough)

When a foreign object only partially blocks the airway, the person can still breathe — perhaps with difficulty — and can cough forcefully. A forceful, effective cough generates airway pressures far higher than any manual technique can achieve (500 mmHg vs. approximately 100 mmHg for abdominal thrusts). Encouraging coughing is the first response for a conscious choking victim who can still breathe and cough effectively.

Never perform abdominal thrusts on someone who is coughing forcefully or breathing adequately — let their cough work.

Complete Obstruction (Silent Choking)

Complete airway obstruction is a life-threatening emergency. Signs include:

• Sudden inability to speak, cry, cough, or breathe
• High-pitched noise or silence when attempting to breathe
• Clutching the throat with both hands (the universal choking sign)
• Bluish coloration of lips and fingertips (cyanosis) — appears within minutes
• Panic and extreme distress

A person with complete airway obstruction will lose consciousness within minutes from hypoxia. Immediate action is required.

The Heimlich Maneuver: Step-By-Step For Conscious Adults

Recognition

First ask: "Are you choking? Can you speak?" If they cannot speak and are showing signs of distress, proceed immediately.

BACK BLOWS (FIVE BLOWS FIRST — CURRENT GUIDELINES)

Current American Heart Association and Red Cross guidelines recommend alternating back blows with abdominal thrusts:

1. Position yourself to the side and slightly behind the choking person
2. Support their chest with one hand and lean them slightly forward
3. Deliver 5 firm back blows with the heel of your hand between the shoulder blades
4. Check after each blow — if the object is expelled, stop

Abdominal Thrusts (Heimlich Maneuver)

1. Stand directly behind the person
2. Wrap your arms around their waist
3. Make a fist with one hand; place the thumb side against the abdomen, just above the navel and well below the breastbone (xiphoid process)
4. Grasp your fist with the other hand
5. Give a quick, firm inward and upward thrust
6. Repeat up to 5 times, checking between each thrust

Continue alternating 5 back blows and 5 abdominal thrusts until the object is expelled, the person can breathe and speak, or the person becomes unconscious.

MECHANISM OF ACTION: Why does this work? The rapid upward thrust compresses the diaphragm and pushes residual air from the lungs upward through the trachea — creating a sudden burst of air pressure that acts like a cough, potentially expelling the obstructing object.

If The Person Becomes Unconscious

If the choking person loses consciousness:

1. Lower them carefully to the floor, supporting their head and neck
2. Call 911 if not already done
3. Begin CPR — start with chest compressions (30 compressions before rescue breaths)
4. Before each rescue breath attempt, look in the mouth for a visible object and remove it if visible — but do not perform blind finger sweeps (which can push the object deeper)
5. Continue CPR until the object is expelled, breathing resumes, or help arrives

Variations For Special Circumstances

CHOKING IN INFANTS (UNDER 1 YEAR)

The Heimlich maneuver is NOT used for infants. The combination of their small size and fragile bones requires a modified approach:

1. Hold infant face-down along your forearm, supporting head lower than chest, head in your palm
2. Deliver 5 back blows between shoulder blades with heel of hand
3. Turn infant face-up, supporting head, keeping it lower than body
4. Deliver 5 chest thrusts: 2 fingers on center of chest, just below nipple line; press down 1.5 inches per thrust
5. Alternate 5 back blows and 5 chest thrusts
6. Check mouth after each sequence; remove object only if visible

Do not use abdominal thrusts for infants.

Pregnant Women And Obese Individuals

When abdominal thrusts are not feasible due to pregnancy or body habitus:

Use chest thrusts:

1. Stand behind the person
2. Position hands on the center of the breastbone (not the lower tip/xiphoid)
3. Give firm inward thrusts (not upward) to the chest
4. Repeat as needed

Self-Treatment When Alone

If you are alone and choking:

1. Make a fist and thrust inward and upward on your own abdomen (same hand position as for a victim)
2. Alternatively, thrust your upper abdomen against a hard edge — a chair back, countertop, or railing

After The Heimlich Maneuver

Even if the choking was successfully resolved, seek medical evaluation afterward — abdominal thrusts can cause injury to internal organs (ribs, liver, spleen, stomach) and any persistent discomfort, abdominal pain, or breathing difficulty warrants assessment.

If the object was not expelled and the person lost consciousness and was resuscitated, hospital evaluation is essential to ensure the airway is clear and to assess for injury.

Prevention Of Choking

Cut food into small pieces, especially for young children, older adults, and people with swallowing difficulties. Eat slowly. Avoid talking, laughing, or walking while eating. Keep small objects away from young children (Legos, coins, button batteries). Ensure adequate dental care and properly fitting dentures in older adults — poor chewing is a major choking risk factor.

Formal Training

Hands-on practice with mannequins dramatically improves technique effectiveness in a real emergency. The American Red Cross, American Heart Association, and many community organizations offer first aid/choking response training. The Pediatric First Aid variation for infants is particularly worth learning if you spend time with young children.