Yes, the Heimlich maneuver works. It has a reported success rate of about 86.5% at dislodging foreign objects from the airway. It remains one of the most effective bystander interventions for a choking emergency, and it requires no equipment or medical training to perform.
How It Dislodges a Stuck Object
The maneuver works by creating an artificial cough. When someone wraps their arms around a choking person and delivers a sharp inward-and-upward thrust to the upper abdomen, that force pushes the diaphragm up into the chest cavity. This rapidly increases pressure inside the lungs and airway, mimicking the burst of air your body produces during a natural cough but with more force. That pressurized air shoots upward and can push the stuck object out of the airway.
The thrust is placed about two inches above the belly button, below the rib cage. Five quick thrusts in succession is the standard technique. The positioning matters: too low and you won’t generate enough pressure on the diaphragm, too high and you risk injuring the ribs or sternum.
How Effective It Is Compared to Other Techniques
A large registry analysis compared outcomes for choking victims who received abdominal thrusts, back blows, or no intervention at all. Both techniques significantly outperformed doing nothing. Among patients who received abdominal thrusts, 38% had favorable neurological outcomes, compared to 16% for those who received no intervention. Back blows also performed well, with 31% achieving favorable outcomes.
Interestingly, back blows were more strongly associated with survival than abdominal thrusts in that analysis. This is one reason current first aid guidelines from organizations like the American Heart Association and Red Cross recommend starting with five back blows before moving to five abdominal thrusts, alternating between the two until the object comes out or the person loses consciousness. The combination covers both bases: back blows use gravity and vibration to shake the object loose, while abdominal thrusts use air pressure to force it out.
When to Use It and When Not To
The key distinction is between partial and complete choking. If someone is coughing loudly, making sounds, or able to speak (even with difficulty), their airway is only partially blocked. In that case, you should not intervene with the Heimlich maneuver. Their body’s own cough reflex is working, and physical intervention could actually shift the object into a worse position. Stay with them, encourage them to keep coughing, and watch closely.
The Heimlich maneuver is for complete obstruction: the person cannot breathe, cannot cough, cannot speak, and may clutch their throat. Their face may turn blue or darker in color. This is when you act. The classic “universal choking sign,” both hands gripping the throat, is a reliable signal, but silence is the biggest clue. A person who is truly choking makes no sound at all.
Special Situations That Require a Different Approach
The standard abdominal thrust doesn’t work for everyone. For pregnant people or anyone whose midsection is too large to wrap your arms around, chest thrusts are the alternative. You place your hands at the base of the breastbone, just above where the lowest ribs meet, and press hard into the chest with a quick thrust. The mechanism is the same: you’re compressing the chest to force air upward through the airway.
For infants under one year old, abdominal thrusts are not used at all because an infant’s internal organs are fragile and positioned differently. Instead, you lay the baby face-down along your forearm with the head pointed downward and deliver up to five firm blows between the shoulder blades with the heel of your hand. If that doesn’t work, you flip the baby face-up and give five chest compressions using two fingers on the breastbone, just below the nipple line. You alternate between back blows and chest thrusts until the object comes out.
Performing It on Yourself
If you’re choking and alone, you can still use this technique. Make a fist and place the thumb side against your upper abdomen, below the rib cage and above the navel. Grab that fist with your other hand and thrust inward and upward, hard. Repeat as needed.
A potentially better option if you’re near furniture: lean your upper abdomen over the back of a chair, the edge of a table, or a railing and thrust yourself against it. A small study found that chair-assisted self-thrusts generated greater airway pressures than the conventional self-administered version. Since most choking happens while eating, and most eating happens while seated, there’s usually a chair within reach.
Risks and Complications
The force required to dislodge a choking hazard is significant, and it can cause injury. The most common complications are vomiting and rib fractures. These are generally manageable and far preferable to suffocation.
Rarer but more serious injuries have been documented: rupture of the stomach or esophagus, tears in the spleen or liver, diaphragm hernias, and in very rare cases, damage to blood vessels including the aorta. The risk of complications increases with the number of thrust attempts, the age of the person (older adults are more vulnerable), pre-existing health conditions, and the inexperience of the person performing the maneuver.
Even after a successful rescue where the person feels completely fine, it’s worth getting a medical evaluation. Internal injuries from abdominal thrusts don’t always cause immediate symptoms. Bruising to organs, small tears, or air leaking into the chest cavity (a condition called pneumomediastinum, caused by tiny air sacs in the lungs rupturing under the sudden pressure change) can develop hours later. A quick check can catch problems before they become dangerous.
Why 86.5% Is Not 100%
The maneuver fails in roughly one out of seven attempts. Several factors influence whether it works: the size, shape, and texture of the object (smooth, round items like grapes or hard candy are harder to dislodge than irregular chunks of food), how deeply the object is lodged, and how effectively the thrusts are delivered. Incorrect hand placement, insufficient force, or thrusting at the wrong angle all reduce effectiveness.
When the Heimlich maneuver fails and the person loses consciousness, the protocol shifts to calling emergency services and beginning CPR. Chest compressions during CPR generate similar airway pressures and can sometimes dislodge the object. Each time you open the airway to give a breath, you should look in the mouth for the object and remove it if visible.