The Heimlich maneuver is an emergency technique that uses quick upward thrusts to the abdomen to force air out of a choking person’s lungs, pushing a trapped object out of their airway. Developed in 1974 by American surgeon Henry Heimlich, it remains one of the most widely recognized lifesaving techniques in the world. Both the American Red Cross and the American Heart Association endorse it as a frontline response to choking, and it requires no equipment or training beyond knowing the steps.
How It Works
When food or another object gets lodged in the windpipe, normal breathing stops. Coughing, which is the body’s natural way of clearing the airway, may not generate enough force to dislodge it. The Heimlich maneuver solves this by compressing the lungs from the outside, creating an artificial burst of air pressure that shoots upward through the windpipe and pushes the object out, much like squeezing a tube of toothpaste from the bottom.
Heimlich originally developed the technique after observing that the previously recommended method of sharp back blows wasn’t reliably freeing trapped objects. His approach targeted the diaphragm and lungs directly, and it quickly became the standard choking response worldwide.
How to Perform It on an Adult or Child
Stand behind the choking person and wrap your arms around their waist. Make a fist with one hand and place the thumb side against their abdomen, above the navel and below the rib cage. Grab your fist with your other hand and press inward and upward with a quick, forceful thrust. Each thrust should be a distinct, sharp motion rather than a steady squeeze. Repeat until the object comes out or the person can breathe and cough on their own.
If the person is pregnant, or if their body size makes it difficult to wrap your arms around the abdomen, use chest thrusts instead. Place your hands at the base of the breastbone, just above where the lowest ribs meet. Press hard into the chest with a quick thrust. The mechanics are the same: you’re compressing air upward to force the obstruction out.
Why Infants Need a Different Approach
Abdominal thrusts should never be used on infants under one year old. Their livers are proportionally larger and more exposed than in older children, making organ injury a real risk. The recommended technique for a choking infant alternates between back blows and chest thrusts.
For back blows, lay the infant face-down along your forearm, using your thigh for support, with the head angled lower than the body. Deliver up to five firm strikes between the shoulder blades with the palm of your hand. Then flip the infant face-up on your forearm, again keeping the head lower, and place two fingers on the center of the breastbone just below the nipple line. Give up to five quick chest compressions, pressing down roughly half to one-third the depth of the chest. Continue cycling between five back blows and five chest thrusts until the object comes free or the infant loses consciousness.
How to Save Yourself When You’re Alone
Choking while alone is one of the most dangerous scenarios because panic sets in fast. You can perform a version of the maneuver on yourself. Make a fist and place the thumb side just below your rib cage and above your navel. Grab your fist with your other hand and thrust forcefully inward and upward.
If your own thrusts aren’t generating enough force, lean your upper abdomen over a hard edge, like the back of a chair, a countertop, or a railing. Then press your body weight against it with a sharp forward motion, letting gravity assist. Repeat until the object clears.
What Happens if the Person Goes Unconscious
If a choking person becomes unresponsive, lower them carefully to the ground and call emergency services immediately. At this point, the approach shifts to CPR with chest compressions. Compressing the chest about two inches deep creates enough pressure to potentially move the obstruction while also circulating blood. Each time you open the airway to give rescue breaths, look in the mouth for the object. If you can see it, remove it. If the chest doesn’t rise after repositioning the head and attempting two breaths, continue compressions.
How Effective Is It
A registry analysis of over 400 choking patients found that those who received abdominal thrusts from a bystander had significantly better neurological outcomes, with 38% achieving favorable recovery compared to just 16% among those who received no intervention. Back blows also improved outcomes, with 31% favorable recovery. The key takeaway is that doing something, whether abdominal thrusts or back blows, dramatically improves the chances compared to waiting for emergency responders to arrive. The FDA has specifically encouraged the public to use these established protocols before considering any other intervention, noting their high success rate and the advantage of requiring no special equipment.
Possible Injuries From the Maneuver
The force needed to clear an airway obstruction is substantial, and that force can cause injuries. Rib fractures and bruising are the most common complications. Internal organ damage is possible but less frequent. These risks are worth taking during a genuine choking emergency, where the alternative is suffocation, but they’re the reason medical evaluation afterward matters.
Even if the object comes out and the person feels fine, a medical checkup is recommended. Residual fragments can remain in the airway, and the thrusts themselves may have caused damage that isn’t immediately obvious. Anyone who still has difficulty breathing, throat pain, trouble swallowing, chest pain, or abdominal pain after the object is removed should be evaluated promptly.