A chest thrust is a first aid technique used to clear a blocked airway when someone is choking. It works by pushing sharply inward on the breastbone to force air up through the windpipe and dislodge whatever is stuck. It’s the go-to alternative when standard abdominal thrusts (the Heimlich maneuver) aren’t safe or practical, particularly for pregnant people, larger individuals, and infants.
How a Chest Thrust Works
When food or another object gets lodged in the airway, the goal is to create a sudden burst of air pressure beneath the blockage, essentially mimicking a powerful cough. Abdominal thrusts accomplish this by pushing up on the diaphragm. Chest thrusts take a more direct route: compressing the chest cavity itself forces air out of the lungs and up through the throat. Research on anesthetized volunteers found that chest thrusts actually produced significantly better airway pressures than abdominal thrusts, which is one reason some emergency medicine researchers have argued they should be used more broadly.
When Chest Thrusts Are Used Instead of Abdominal Thrusts
The 2025 American Heart Association guidelines recommend cycles of 5 back blows followed by 5 abdominal thrusts as the standard approach for adults with severe choking. But several situations make abdominal thrusts either impossible or unsafe:
- Pregnancy (late stages): Pressing forcefully into the abdomen risks injury to the mother or baby. Chest thrusts bypass the abdomen entirely.
- Larger body size: If you can’t wrap your arms around the person’s midsection, abdominal thrusts won’t generate enough force. Chest thrusts work higher up where you can get a better grip.
- Wheelchair users: Positioning for abdominal thrusts can be difficult or ineffective when someone is seated in a wheelchair.
- Infants under 1 year: Abdominal thrusts are not used on babies because of the risk of organ damage. Chest thrusts paired with back blows are the standard technique.
How to Perform Chest Thrusts on an Adult
Stand behind the person and wrap your arms around their chest, under their armpits. Make a fist and place it on the middle of the breastbone, between the nipples. Cover your fist with your other hand. Pull sharply inward, pressing firmly into the chest with a quick backward thrust. The motion is similar to a Heimlich maneuver but aimed at the chest instead of the stomach.
Give 5 chest thrusts in a row, then check whether the object has been dislodged. If the person is still choking, repeat cycles of 5 thrusts until the blockage clears or the person loses consciousness. If they become unresponsive, lower them to the ground and begin CPR. The chest compressions used in CPR generate enough airway pressure to potentially expel the foreign body on their own.
Chest Thrusts for Infants
For babies under 12 months, the technique looks quite different. Place the infant face-down along your forearm, supporting their head, and deliver 5 firm back blows between the shoulder blades using the heel of your hand. Then flip the baby face-up on your forearm and give 5 chest thrusts using two fingers pressed on the center of the breastbone, just below the nipple line. Push down about 1.5 inches with each thrust. Alternate between 5 back blows and 5 chest thrusts until the object comes out or the baby becomes unresponsive.
Never use abdominal thrusts on an infant. Their internal organs are fragile and sit higher in the torso than in adults, making abdominal compression dangerous.
Safety Compared to Abdominal Thrusts
One of the reasons chest thrusts are preferred in certain situations is their safety profile. A systematic review published in the Eurasian Journal of Emergency Medicine cataloged a striking range of injuries linked to abdominal thrusts: stomach rupture, rib fractures, torn spleens, liver lacerations, esophageal perforation, aortic damage, diaphragm rupture, and pancreatic injury. These complications were especially common in elderly patients. The review’s authors concluded that chest thrusts and chest compressions should be considered safer alternatives.
That said, chest thrusts aren’t risk-free. Any forceful compression of the chest can crack a rib, particularly in older adults or people with osteoporosis. But the risk of serious internal organ damage is lower because the force is directed at the ribcage, a bony structure designed to absorb impact, rather than the soft abdomen. In a life-threatening choking emergency, a cracked rib is a minor trade-off for a clear airway.
What Happens if Thrusts Don’t Work
If a choking person stops responding, they need to be laid flat on their back immediately. At that point, back blows and any type of standing thrust become impractical. Start CPR with chest compressions, which serve double duty: they keep blood circulating and generate enough pressure in the airway to potentially push the obstruction out. Each time you open the airway to give a rescue breath, look in the mouth for the object and remove it if you can see it. Call emergency services if someone hasn’t already.
The transition from choking rescue to CPR is critical because a blocked airway leads to oxygen deprivation within minutes. The brain begins to suffer damage after roughly 4 to 6 minutes without oxygen, so acting quickly through the full sequence of back blows, thrusts, and CPR if needed gives the best chance of a good outcome.