An abdominal thrust is a first-aid technique used to dislodge an object stuck in someone’s airway. You may know it by its original name, the Heimlich maneuver. It works by forcing a burst of air up from the lungs, essentially creating an artificial cough powerful enough to push a foreign body out of the throat. Dr. Henry Heimlich first introduced the technique in 1974, and it remains the standard choking rescue method recommended by the American Heart Association.
How It Works Inside the Body
When you press forcefully inward and upward on someone’s abdomen, you push the diaphragm upward. This rapidly compresses the lungs, generating a sharp spike in pressure inside the chest. That pressure wave travels up through the airway and acts like a powerful, forced cough, pushing the stuck object out.
The pressure created by abdominal thrusts meets or exceeds what the body can produce through a natural cough. That’s why the technique works when a person’s own cough reflex has failed: the obstruction is too complete for air to move around it naturally, but the sudden external compression generates enough force to dislodge it.
When to Use Abdominal Thrusts
Not every choking episode calls for intervention. If someone is coughing forcefully, their airway is only partially blocked, and coughing alone may clear it. Leave them alone and let the cough do its job.
Abdominal thrusts are for severe obstruction, when a person cannot cough, speak, cry, or laugh. You’ll often see them clutching their throat, turning red or blue, or making no sound at all despite clearly struggling to breathe. That silence is the key signal. A person who can still make noise still has air moving. A person who can’t is in immediate danger.
Step-by-Step Technique for Adults and Children
The 2025 American Heart Association guidelines recommend cycles of 5 back blows followed by 5 abdominal thrusts, repeated until the object comes out or the person becomes unresponsive.
To perform the abdominal thrusts, stand directly behind the choking person (or kneel if they’re a child). Wrap your arms around their waist. Make a fist and place it midway between the belly button and the bottom of the ribcage, thumb side against the abdomen. Grab that fist with your other hand. Pull sharply inward and upward in a firm thrusting motion. Repeat five times in quick succession, then switch back to five back blows if the object hasn’t cleared.
Each thrust should be a distinct, forceful motion, not a squeeze. You’re trying to generate a sudden burst of pressure, not steady compression.
Performing It on Yourself
If you’re choking and alone, you can perform a version of the maneuver on yourself. Place your fist above your navel with your thumb just below your rib cage. Grab it with your other hand and push forcefully inward and upward. You can also lean over the back of a chair, a table edge, or a railing and thrust your upper abdomen against the hard edge. Repeat until the blockage clears.
Modified Technique for Pregnancy and Obesity
For someone who is pregnant or whose body size makes it difficult to reach around the abdomen, the thrust placement changes. Instead of pressing on the abdomen, position your fist on the breastbone (the center of the chest, between the nipples). The inward thrust motion stays the same, but the higher placement avoids pressure on the belly while still compressing the lungs enough to generate airflow.
Why It’s Not Used on Infants
Abdominal thrusts should never be performed on infants under one year old. Their livers are proportionally larger and sit higher in the abdomen, making them vulnerable to serious organ damage from the upward thrust. For a choking infant, the recommended approach is alternating sets of 5 back blows and 5 chest thrusts (pressing on the breastbone with two fingers) until the object is dislodged or the infant becomes unresponsive.
Risks and Possible Injuries
Abdominal thrusts save lives, but they involve real force applied to soft tissue, and injuries do happen. Documented complications include rib fractures (particularly in older adults), stomach tears along the inner wall, and damage to the diaphragm, pancreas, liver, or esophagus. In rare cases, the aorta has been injured, which carries the highest mortality risk among reported complications.
Rib fractures tend to occur in elderly women, with reported cases involving patients in their 70s, 80s, and 90s. Stomach rupture was actually the first life-threatening complication ever documented, reported just one year after the technique was introduced. Pancreatic and liver injuries have been reported primarily in children and elderly men, respectively.
These complications are uncommon relative to the number of successful rescues performed every year, but they underscore an important point: anyone who receives abdominal thrusts should be evaluated by a medical professional afterward, even if the choking episode resolved and they feel fine. Internal injuries from the maneuver can produce delayed symptoms like abdominal pain, chest pain, difficulty swallowing, or shortness of breath.
What Happens if the Person Goes Unresponsive
If cycles of back blows and abdominal thrusts don’t clear the obstruction and the person loses consciousness, the situation shifts to a cardiac arrest protocol. Lower them to the ground and begin CPR. Each time you open the airway to deliver a breath, look in the mouth for the object. If you can see it, remove it. If not, continue chest compressions. The compressions themselves can sometimes generate enough force to move the obstruction. Call emergency services immediately if you haven’t already.