Home > Encyclopedia of Nursing & Allied Health > Heimlich Maneuver

Definition

The Heimlich maneuver is an emergency procedure for removing a foreign object lodged in the airway that is preventing a person from breathing.

Purpose

Each year, approximately 3,000 adults die in the United States because they accidentally inhale rather than swallow food. The food gets stuck and blocks their trachea (windpipe), making breathing impossible. Death follows rapidly unless the food or other foreign material can be displaced from the airway. This condition is so common it has been nicknamed the "café coronary."

In 1974, Dr. Henry Heimlich first described an emergency technique for expelling foreign material blocking the trachea. This technique, now called the Heimlich maneuver or abdominal thrust, is simple enough that it can be performed immediately by anyone trained in the maneuver. The Heimlich maneuver is a standard part of all first aid courses.

The theory behind the Heimlich maneuver is that by compressing the abdomen below the level of the diaphragm, air is forced out of the lungs under pressure. This air dislodges the obstruction in the trachea and brings the foreign material back up into the mouth.

The Heimlich maneuver is used mainly when solid materials such as food, coins, vomit, or small toys are blocking the airway. There has been some controversy about whether the Heimlich maneuver is appropriate to use routinely on near-drowning victims. After several studies of the effectiveness of the Heimlich maneuver on reestablishing breathing in near-drowning victims, the American Red Cross and the American Heart Association both recommend that the Heimlich maneuver be used only as a last resort after traditional airway clearance techniques and cardiopulmonary resuscitation (CPR) have been tried repeatedly and failed; or if it is clear that a solid foreign object is blocking the airway.

Precautions

Incorrect application of the Heimlich maneuver can damage the chest, ribs, heart or internal organs of the person on whom it is performed. People may also vomit after being treated with the Heimlich maneuver. It is important to prevent aspiration of the vomitus.

Description

The Heimlich maneuver can be performed on all people. Modifications are necessary if the person choking is very obese, pregnant, a child, or an infant.

Indications that a person's airway is blocked include:

• inability to speak or cry out
• face turning blue from lack of oxygen
• desperate grabbing at the throat
• weak cough with labored breathing producing a high-pitched noise
• all of the above, followed by unconsciousness

Performing the Heimlich maneuver on adults

To perform the Heimlich maneuver on a conscious adult, the rescuer stands behind the affected person, who may be either sitting or standing. The rescuer makes a fist with one hand and places it, thumb toward the person choking, below the rib cage and above the waist. The rescuer encircles the other person's waist, placing the other hand on top of the fist.

In a series of six to 10 sharp and distinct thrusts upward and inward, the rescuer attempts to develop enough pressure to force the foreign object back up the trachea. If the maneuver fails, it is repeated. It is important not to give up if the first attempt fails. As the choking person is deprived of oxygen, the muscles of the trachea relax slightly. Because of this loosening, it is possible that a foreign object may be expelled on a second or third attempt.

If the individual choking is unconscious, the rescuer should place the person supine on the floor; bend the chin forward; make sure the tongue is not blocking the airway; and feel in the mouth for any foreign objects, being careful not to push them further into the airway. The rescuer kneels astride the choking person's thighs and places the fists between the bottom of the choking person's breast-bone and navel. The rescuer then executes a series of six to 10 sharp compressions by pushing inward and upward.

After the abdominal thrusts, the rescuer repeats the process of lifting the chin, moving the tongue, feeling for and possibly removing any foreign material. If the airway is not clear, the rescuer repeats the abdominal thrusts as often as necessary. If the foreign object has been removed, but the victim is not breathing, the rescuer starts CPR.

Performing the Heimlich maneuver under special circumstances

OBVIOUSLY PREGNANT AND VERY OBESE PEOPLE. The main difference in performing the Heimlich maneuver on this group of people is in the placement of the fists. Instead of using abdominal thrusts, chest thrusts are used. The fists are placed against the middle of the breastbone (sternum), and the motion of the chest thrust is in and downward, rather than upward. If the person choking is unconscious, the chest thrusts are similar to those used in CPR.

CHILDREN. The technique in children over one year of age is the same as in adults, except that the amount of force used is less than that used with adults, in order to avoid damaging a child's ribs, breastbone, and internal organs.

INFANTS UNDER ONE YEAR OLD. The rescuer sits down and positions the infant along the rescuer's forearm with the infant's face pointed toward the floor and at a lower level than the infant's chest. The rescuer's hand supports the infant's head. The forearm rests on the rescuer's own thigh for additional support. Using the heel of the other hand, the rescuer administers four or five rapid blows to the infant's back between the shoulder blades.

After administering the back blows, the rescuer sandwiches the infant between both arms. The infant is turned over so that it lies face up, supported by the rescuer's opposite arm. Using the free hand, the rescuer places the index and middle finger on the center of the breastbone and makes four sharp chest thrusts. This series of back blows and chest thrusts is alternated until the foreign object is expelled.

SELF-ADMINISTRATION OF THE HEIMLICH MANEUVER. To apply the Heimlich maneuver to oneself, a choking person should make a fist with one hand and place it in the middle of the body at a spot above the navel and below the breastbone, then grasp the fist with the other hand and push sharply inward and upward. If this fails, the choking person should press the upper abdomen over the back of a chair, edge of a table, porch railing or something similar, and thrust up and inward until the object is dislodged.

Preparation

Any person can be trained to perform the Heimlich maneuver. Knowing how to perform it may save someone's life. Before doing the maneuver, it is important to

determine if the airway is completely blocked. If the choking person can talk or cry, the Heimlich maneuver is not appropriate. If the airway is not completely blocked, the choking person should be allowed to try to cough up the foreign object without assistance.

Aftercare

Once the obstruction is removed, most persons who experience an episode of choking recover without any further care. Persons who have an obstruction that cannot be dislodged but are able to breathe should be taken to an emergency room for treatment.

---

KEY TERMS

---

Diaphragm—The thin layer of muscle that separates the chest cavity, which contains the lungs and heart, from the abdominal cavity, which contains the intestines and digestive organs.

Sternum—The breastbone. The sternum is located over the heart, is the point of attachment for ribs at the front of the body and provides protection to the heart beneath it.

Trachea—The windpipe. A tube extending from below the voice box into the chest where it splits into two branches, the bronchi, that lead to each lung.

---

Complications

Many people vomit after being treated with the Heimlich maneuver. Depending on the length and severity of the choking episode, the person may need to be taken to a hospital emergency room. Occasionally, one or more ribs of the choking person may be broken during administration of the Heimlich maneuver. Applying the Heimlich maneuver too vigorously may result in an injury to the internal organs of the choking person. There may be some local pain and tenderness at the point where the rescuer's fist was placed. In infants, a rescuer should never attempt to sweep the baby's mouth without looking to remove foreign material. This is likely to push the material farther down the trachea. If the foreign material is not removed, the person choking will die from lack of oxygen.

Results

The Heimlich maneuver usually results in the expulsion and removal of an obstruction in the throat. The choking person suffers no permanent effects from the episode.

Health care team roles

Anyone can be trained to successfully apply the Heimlich maneuver. Most of the applications each year are provided by trained volunteers. Health professionals may become involved. Paramedics may apply the Heimlich maneuver to a choking person. Physicians, physician assistants and nurses may provide additional treatment in a hospital emergency room. Nurses may provide some follow-up care.

L. Fleming Fallon, Jr., MD, PhD, DrPH