The Heimlich Maneuver, formally known as abdominal thrusts, is an emergency procedure designed to clear a person’s upper airway obstructed by a foreign object. This technique works by rapidly increasing pressure within the abdomen and chest cavity, creating an artificial cough. The sudden burst of air pressure from the lungs forcefully expels the blockage. This intervention is a globally recognized first-aid response for choking and is taught in basic life support courses worldwide.
Quantifying Success Rates
Determining a precise, universally accepted success rate for the Heimlich Maneuver is challenging because ethical constraints prohibit controlled studies on human choking victims. Efficacy is primarily assessed through observational data, case reports, and retrospective analyses of emergency medical services (EMS) incidents. Despite the difficulty in obtaining definitive statistics, the maneuver is widely considered the most effective non-invasive method for relieving a severe airway obstruction.
One large retrospective study analyzing EMS data in the United States found that abdominal thrusts successfully removed the obstruction in approximately 46.6% of reported cases. This figure represents all attempts in a real-world emergency setting, including those performed by untrained bystanders or in complex circumstances. For children under 15 years old, the recorded success rate was notably higher, reaching 60.2%.
When the maneuver is performed correctly and promptly, some research suggests the success rate can approach 80% to 85%. The procedure generates significant intrathoracic pressure, mimicking a powerful cough, which is the physical mechanism behind its effectiveness. Its immediate application by bystanders solidifies its standing as the standard of care for a conscious choking person.
The Critical Role of Proper Technique
The success of abdominal thrusts relies on the rescuer’s correct execution of the technique to maximize the pressure gradient behind the object. For a conscious adult, the rescuer stands behind the victim, wrapping their arms around the waist. The rescuer makes a fist with one hand and places the thumb side against the abdomen, slightly above the navel and well below the rib cage.
The second hand grasps the fist, and a quick, forceful thrust is delivered inward and upward, as if attempting to lift the person. These rapid thrusts compress the diaphragm and lungs, forcing the remaining air out and generating the high-pressure burst. This artificial cough is repeated up to five times, with the rescuer checking between each attempt to see if the obstruction has cleared.
Technique must be adapted for specific populations where standard abdominal thrusts are not feasible or safe. For individuals who are pregnant or obese, the rescuer performs chest thrusts instead. In this variation, the hands are placed on the center of the breastbone, and the thrusts are delivered straight back, avoiding pressure on the abdomen.
Infants require a completely different approach due to the fragility of their anatomy, involving a sequence of five back blows followed by five chest thrusts. The infant is held face down along the rescuer’s forearm for the back blows, and then turned face up for the two-finger chest thrusts. This modified protocol ensures the child’s safety while still applying the necessary forces to clear the airway.
Variables Influencing the Outcome
Several factors influence the success of the Heimlich Maneuver in an emergency. The speed of intervention is a major determinant, as brain damage can occur within minutes of complete airway blockage. A lower level of impaired consciousness in the victim is associated with a higher success rate, since victims who are becoming unresponsive are more difficult to save.
The physical characteristics of the obstructing object also play a role; a smooth, round object creating a near-perfect seal is often more difficult to dislodge than an irregularly shaped one. Complete obstructions, where no air can pass, respond better to the thrusts than partial blockages where the victim can still cough forcefully. The victim’s underlying health condition, such as frailty or osteoporosis, can impact the force that can be safely applied, potentially limiting the maneuver’s effectiveness.
Immediate Aftercare and Follow-up
Regardless of whether the abdominal thrusts successfully expel the foreign object, immediate medical evaluation by calling emergency services is necessary. Even successful interventions carry a risk of internal injury due to the forceful compression of the upper abdomen. Complications can include rib fractures, bruising of internal organs, or more serious injuries like spleen laceration or gastric rupture.
A medical professional must assess the victim for any internal damage and ensure the airway is completely clear. In some cases, the object may have been partially dislodged but not fully expelled, or it may have moved further down the airway where it still poses a risk. Follow-up is necessary to identify and treat these potential hidden injuries.
Should the person become unconscious while the rescuer is attempting to clear the airway, the procedure must immediately transition to cardiopulmonary resuscitation (CPR). The victim should be lowered gently to the floor, and the rescuer should begin chest compressions. The chest compressions used in CPR may serve the dual purpose of circulating blood and potentially dislodging the object.