Recently, the topic “Heimlich Maneuver Updated” has surged to the top of trending searches, drawing widespread attention.
First aid for foreign body airway obstruction, a life-saving essential skill, has once again become a hot topic of discussion.
Being “choked” medically requires vigilance for “foreign body airway obstruction,” which can cause asphyxiation within minutes, leading to severe hypoxia in the body and potentially endangering life in a short time.
Many people are wondering, has the first aid rule changed? What exactly is new about this “update”?
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1. The “Operation Sequence” in the new guidelines is the most notable change.
Recently, the American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR) have updated the Heimlich maneuver based on the latest research evidence. The most notable change concerns the sequence of operations.
The new guidelines suggest:
The new international guidelines for first aid in foreign body airway obstruction have adjusted the core steps for severely choking (foreign body stuck in throat) adults. The key change is shifting from “abdominal thrusts alone (Heimlich maneuver)” to “first perform 5 back blows, if ineffective, then perform 5 abdominal thrusts, alternating in this cycle.” This places greater emphasis on safe, efficient, and unified rescue principles.
Fast Response: The shorter the choking time, the greater the chance of survival and recovery.
Back blows are simpler to perform and can be administered immediately upon discovering choking, helping to relieve the obstruction faster and buy time for subsequent rescue efforts.
Low Risk: Back blows are relatively gentle and almost never cause rib fractures or internal organ injuries.
Prioritizing their use can reduce unnecessary abdominal thrusts and their potential risks.
High Efficiency: Back blows primarily loosen the foreign object through vibration and gravity; abdominal thrusts attempt to expel it by creating upward pressure.
Using the “vibration” and “pressure” methods sequentially can handle more types of blockages than a single method, increasing the success rate.
2. For children over 1 year old and adults: Back blows first, then abdominal thrusts.
For adults and children who can stand with severe foreign body airway obstruction, the new guidelines explicitly state for the first time that the rescuer’s hand force should be controlled between 3-5 kilograms. The force for abdominal thrusts on adults is about 5 kilograms, applied at a 45-degree angle to the horizontal line.
Lean forward, back blows first.
The patient spreads their legs shoulder-width apart, leans their body forward. Use the heel of the palm to deliver 5 forceful blows to the midpoint between the shoulder blades. Observe if the foreign object is expelled.
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Then abdominal thrusts.
If the foreign object is not expelled, then employ the abdominal thrust method, remembering “scissors, rock, cloth.”
Scissors: Locate a spot two finger-widths above the navel.
Rock: Make a fist with one hand and place it there.
Cloth: Wrap the other hand around the fist, and deliver 5 quick, forceful thrusts inward and upward into the abdomen.
If the foreign object is not expelled, repeat the alternating cycle of “5 back blows – 5 abdominal thrusts.”
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3. For infants under 1 year old: Back blows + chest thrusts, abdominal thrusts are prohibited.
Liu Siqi stated that the new guidelines further emphasize age-specific and precise rescue.
For infants under 1 year old, use the sequence of back blows first, followed by chest thrusts. Because an infant’s internal organs are not fully developed, abdominal thrusts are prohibited. Therefore, the “5 back blows – 5 chest thrusts” combination process should be used.
Correct rescue method:
Hold the child’s cheeks between your hands, keeping the child in a head-low, bottom-high position lying on your arm, tilted downward. Use the heel of your palm to deliver 5 forceful blows to the midpoint between the child’s shoulder blades.
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If the foreign object is still not expelled, then hold the child, flip them over, and use the heel of your palm to press on the chest 5 times. Repeat the above actions.
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It should be noted that when performing chest thrusts on an infant, the new guidelines recommend using the heel of the palm for compressions instead of two fingers, to more effectively achieve the required compression depth.
4. For pregnant women and obese individuals, use chest thrusts.
The first aid method for pregnant women and obese individuals completely abandons abdominal thrusts in favor of chest thrusts. The main reasons are that abdominal thrusts may harm the pregnant woman, potentially causing placental abruption or premature birth; for obese individuals, the thicker abdominal fat layer buffers the thrust force, making it difficult to achieve the desired effect.
Correct rescue method: First perform 5 back blows. If the foreign object is not expelled, then perform chest thrusts—the rescuer places their hands overlapping on the middle of the patient’s sternum and delivers quick, forceful thrusts backward.
5. What to do if you are alone and choking?
For a conscious patient with severe foreign body airway obstruction, self-rescue involves a combination of self-administered abdominal thrusts and hard-object-assisted thrusts.
Self-administered abdominal thrusts
Locate a spot two finger-widths above the navel. Make a fist with one hand, thumb-side against the spot. Wrap the other hand around the fist, and deliver quick thrusts upward and inward. Repeat if not expelled.
Hard-object-assisted thrusts
Press the upper abdomen against a hard edge like a chair back or table edge. Lean the body forward and quickly squeeze the abdomen inward and upward, using the reaction force to generate intra-abdominal pressure to impact the foreign object.
How to correctly identify airway obstruction
Experts remind that the Heimlich maneuver is only suitable for patients with severe airway obstruction, whose symptoms include inability to speak, cyanosis (bluish skin), and clutching the throat with both hands.
If the patient only has mild obstruction and can still cough and speak, then maintain observation, encourage them to expel the foreign object through voluntary coughing, and do not immediately perform first aid intervention.
What to do after expelling the foreign object?
After the foreign object is expelled, the patient still needs close observation for at least 15 minutes to check for any residual foreign object or complications.
If vomiting occurs, immediately turn the patient’s head to one side to prevent reflux and secondary choking.
Regarding prevention:
Infants and young children should avoid foods that easily cause choking, such as whole nuts, jelly, peanut butter, and grapes. They must remain seated while eating and avoid talking, laughing, or running. For infants, liquids like milk and vomit are also common causes of choking.
Small objects like balloons, small building blocks, pen caps, coins, and button batteries should be stored properly to prevent children from accidentally swallowing them.
Elderly individuals should pay attention to medication safety. Large pieces of meat should be cut into small pieces and eaten slowly to reduce risk.
