Updates on the Heimlich Maneuver (Abdominal Compressions)

Technique for Adults and Children Over 1 Year

The American Academy of Pediatrics recommends alternating 5 back slaps with 5 abdominal compressions in cases of complete airway obstruction in adults and children over 1 year 1
For partial airway obstruction, the victim should be encouraged to continue coughing without other interventions 2, 3
For conscious victims with complete obstruction, the rescuer should position themselves behind the victim, place their arms around the victim's upper abdomen, and perform abdominal compressions 2
The victim should be leaned forward to allow the object to be dislodged and exit the mouth 3
The rescuer should make a fist and place it between the victim's navel and xiphoid process, grasping it with their other hand, and then pull inward and upward to dislodge the object 2

The American Academy of Pediatrics does not recommend abdominal compressions for infants due to the risk of rupturing abdominal viscera 4, 1
For infants with complete obstruction, the current recommendation is to perform 5 back slaps followed by 5 chest compressions 1
The infant should be placed in a prone position with their head lower than their torso during back slaps 4
Chest compressions should be performed similarly to cardiac compressions, but more vigorously and at a rate of approximately 20 per minute 4

The sequence of care should start by verifying whether the obstruction is partial or complete 2, 1
For complete obstruction, the rescuer should alternate between 5 back slaps and 5 abdominal compressions (in children over 1 year and adults) or 5 chest compressions (in infants) 2, 3, 1
The rescuer should check the victim's mouth after each cycle and remove any visible object 4
The rescuer should attempt to perform 2 rescue breaths at the end of each series of back slaps and abdominal or chest compressions 2
If the victim becomes unconscious at any point, the rescuer should follow the basic life support sequence 2

The American Heart Association recommends verifying complete airway clearance, checking the mouth for visible foreign bodies, attempting rescue breaths, and continuing monitoring after successful back blows that relieve choking in an infant, and if the infant becomes unresponsive, immediately beginning CPR starting with chest compressions 5
The British Medical Journal suggests visually inspecting the mouth after each cycle of 5 back blows and 5 chest compressions, and removing any visible foreign bodies 6
The American Heart Association and the British Medical Journal advise against performing blind finger sweeps, as these can push the object deeper into the larynx or damage the oropharynx 5, 6

The American Heart Association and the British Medical Journal recommend continuing alternating cycles of 5 back blows and 5 chest compressions until the object is expelled or the infant becomes unresponsive 5, 6

The American Heart Association recommends starting CPR with 30 chest compressions, without checking for a pulse first, and then opening the airway and looking for a foreign body 5
The American Heart Association advises removing visible objects only, attempting 2 breaths, and continuing cycles of 30 compressions and 2 breaths 5

The British Medical Journal suggests holding the infant prone along the forearm with the head lower than the chest, and delivering 5 sharp blows to the middle of the back with the heel of the hand 6
The American Heart Association recommends never using abdominal thrusts in infants, due to the risk of rupturing abdominal viscera 5

The American Heart Association notes that liquids are the most common choking cause in infants 5