Yes, the Heimlich Maneuver (Abdominal Thrusts) Is Still Recommended for Choking
If you see someone choking who cannot cough or make sounds, you should perform alternating cycles of 5 back blows followed by 5 abdominal thrusts (Heimlich maneuver) until the object is expelled or the person becomes unconscious. 1
How to Recognize Severe Choking
The person will show:
- Inability to cough or make any sound (this is the key sign)
- Weak or absent cough
- Cannot speak or talk
- Change in color (turning blue/cyanotic)
- Altered mental status
- Clutching at throat (universal choking sign)
The Correct Sequence for Adults and Children Over 1 Year
Start with back blows first, not abdominal thrusts:
Give 5 back blows (slaps): Stand to the side and slightly behind the person, support their chest with one hand, lean them forward, and deliver 5 sharp blows between the shoulder blades with the heel of your other hand 1, 3
Then give 5 abdominal thrusts: Stand behind them, place your fist between the navel and breastbone, grasp it with your other hand, and pull sharply inward and upward 1
Alternate these cycles until the object comes out or they become unconscious 1
Call 911 immediately when you recognize severe choking 1
Why Back Blows Come First Now
This is a change from older teaching. The most recent 2025 American Heart Association guidelines now recommend starting with back blows based on evidence showing they are more effective and cause fewer injuries than abdominal thrusts alone. 1 A cohort study of 709 choking victims found back blows were associated with better obstruction relief rates and fewer injuries compared to abdominal thrusts, and case reports have documented fatal injuries from abdominal thrusts including aortic dissection and gastric rupture. 1
Special Situations
For infants under 1 year: Use 5 back blows alternating with 5 chest thrusts (not abdominal thrusts) because abdominal thrusts can rupture an infant's liver 2, 4
For pregnant women or obese individuals: When you cannot get your arms around their abdomen, use chest thrusts instead of abdominal thrusts 1
Self-administered: If you're alone and choking, you can perform abdominal thrusts on yourself or push your upper abdomen forcefully against a chair back or countertop 5
If They Become Unconscious
Immediately start CPR with chest compressions - do not check for a pulse first. 2, 1 The chest compressions themselves can generate enough pressure to expel the foreign body. 1 After 30 compressions, open the airway and look for a visible object - remove it if you see it, but never do blind finger sweeps as this can push the object deeper. 3, 1
Common Pitfalls to Avoid
- Don't interfere if they can still cough - a strong cough is more effective than any maneuver. Only intervene when coughing becomes weak or absent 2, 1
- Don't do blind finger sweeps - only remove objects you can clearly see 3, 1
- Don't forget to call 911 - even if the object comes out, they need medical evaluation 1
- Don't use abdominal thrusts on infants - use chest thrusts instead 2
Success Rates
Real-world data shows abdominal thrusts have a 46.6% success rate when performed by emergency medical services, with first-attempt success at 41.5%. 6 Multiple interventions are often needed, which is why the alternating approach of back blows and abdominal thrusts is recommended. 7