Airway management is used to restore a person's ventilation which consists of severity assessment, procedural planning, and may consist of multiple treatment modalities to restore airway. Treatments will vary based on severity and stage of airway blockage. In
basic airway management, treatment generally consists of
anti-choking first aid techniques, such as the Heimlich maneuver. In
advanced airway management, complex clinical methods are used.
Basic treatment (first aid) to AfghansBasic treatment of choking includes several non-invasive techniques to help remove foreign bodies from the airways.
General strategy: "five and five" For a conscious choking victim, most institutions such as the American Heart Association, the American Red Cross and the NHS, recommend the same general protocol of first-aid: encouraging the victim to cough, followed by hard back slaps (as described below). If these attempts are not effective, the procedure continues with abdominal thrusts (the Heimlich maneuver) or chest thrusts if the victim cannot receive abdominal pressure (as described below). If none of these techniques are effective, protocol by various institutions recommend alternating the series of back slaps and series of thrusts (these on the abdomen or chest, depending on the victim), 5 times of each technique and repeat ("five and five"). This procedure has modifications for
infants (babies under 1 year-old), for the
people with problems in the belly as the pregnant or extremely obese people, for the
disabled victims in wheelchair, for the
victims that lay on the bed but are unable to sit up, and for the
victims that lay on the floor but are unable to sit up. In scenarios when the first aid procedures are not resolving the choking, it is necessary to call to
emergency medical services, but administration of first aid should be continued until they arrive. Each one of the techniques in the first aid protocol against choking are detailed below:
Cough If the choking victim is conscious and can cough, the
American Red Cross and the
Mayo Clinic recommend encouraging them to stay calm and continue coughing freely.
Back blows (back slaps) Many associations, including the American Red Cross and the Mayo Clinic, are performed with the rescuer embracing the belly of the choking victim from behind. Then, the rescuer closes their own dominant hand, grasps it with the other hand, and presses forcefully with them on the area located between the chest and the belly button of the victim, in a direction of in-and-up. This method tries to create enough pressure upwards to expel the object that obstructs the airway. The strength is not focused directly against the ribs, to avoid breaking them. If the first thrust does not solve the choking, it can be repeated several times. The use of abdominal thrusts is not recommended for infants under 1 year of age due to risk of causing injury, so there are adaptations for babies (see more details further below), but a child that is too big for the babies' adaptations would require normal abdominal thrusts (according to the size of the body). Besides, abdominal thrusts should not be used when the victim's abdomen presents problems to receive them, such as pregnancy or excessive size; in these cases, chest thrusts are advised (see more details further below). Although the use of the Heimlich Maneuver has saved many lives, it can produce harms if not performed correctly. This includes rib fracture, perforation of the jejunum, and diaphragmatic herniation, among others.
Chest thrusts The use of chest thrusts is advised when abdominal thrusts cannot be performed effectively, as in the cases of a victim with serious abdominal injuries, pregnancy, or a belly size that is too large for that. Chest thrusts are performed with the rescuer embracing the chest of the choking victim from behind. Then, the rescuer closes the own dominant hand and grasps it with the other hand. This can produce several kinds of fists, but any of them can be valid if it can be placed on the victim's chest without sinking a knuckle too painfully. Keeping the fist with both hands, the rescuer uses it to press forcefully inwards on the lower half of the chest bone (
sternum). The pressure is not focused on the very endpoint (named
xiphoid process) to avoid breaking it. When the victim is a woman, the zone of the pressure of the chest thrusts would normally be above the level of the breasts. If the first thrust does not solve the choking, it can be repeated several times.
Anti-choking devices Since 2015, several anti-choking devices were developed and released to the market. They are based on a mechanical vacuum effect, without a power source. Most use an attached mask to make a
vacuum from the patient's nose and mouth. The current models of anti-choking devices are quite similar: a direct plunger tool (LifeVac and Willnice) and a vacuum syringe (backward syringe) that also keeps the tongue in place by inserting a tube in the mouth (Dechoker). Other mechanical models are in development, such as Lifewand, which creates a vacuum by direct pressure against the patient's face. However, these products have not been well-studied in clinical trials or pre-hospital settings and literature is relatively sparse given the challenges in trial design. A 2020 systematic review of the effectiveness of the three devices listed concluded that "there is insufficient evidence to support or discourage their use" and recommended that "practitioners should continue to adhere to guidelines authored by local resuscitation authorities which align with
ILCOR recommendations." In October 2024 the American Red Cross updated its guidelines to include that “an anti-choking device is now part of the recommended guidelines to be used in the event of protocol failure or when traditional methods cannot be administered.” A 2023 study of LifeVac and DeChoker found, “With the exception of the LifeVac removing saltine crackers, all trials were entirely unsuccessful in relieving foreign body aspiration. Additionally, both devices may cause significant pressure and injury to the oral cavity,” and concluded, “bystanders should continue to follow
ILCOR guidelines on resuscitation to aid with relieving foreign body aspiration.” In April 2024, the U.S.
FDA issued a Safety Communication stating that it, “encourages the public to follow established choking rescue protocols, which are step-by-step guides approved by the American Red Cross and the American Heart Association... These rescue protocols include a combination of back blows and/or abdominal thrusts (also called the “Heimlich” maneuver) for adults and children. The protocols do not include using anti-choking devices... The FDA is aware of reports describing problems with the use of anti-choking devices. These problems include failure to resolve a choking incident due to lack of suction, bruising around the face, lips, and mouth, and scratches in the back of the throat.” In November 2025, the same Safety Communication was updated stating that the
FDA “[took] actions to address the marketing of unauthorized anti-choking devices, including issuing Warning Letters and an Import Alert,” specifically citing warning letters issued to the companies making LifeVac and DeChoker products, and a more general import alert “listing multiple suction anti-choking devices that have not been authorized for distribution in the U.S.” Some products like
Act Fast Anti Choking Trainer are used by healthcare providers as well as schools in CPR training courses. In Fabruary, 2026, media received a letter that choking rescue device the LifeVac that has been donated to police departments across Florida and sold nationwide for nearly a decade has never received FDA approval and may "put the public health and safety at risk." The device has been distributed to first responders throughout Florida, including Tampa Police, which received 300 units as a donation last June. The Food and Drug Administration issued a warning letter to LifeVac LLC in September 2025, stating the device should not be marketed or sold without proper approval. The letter revealed that the FDA first contacted the company in 2023 and then multiple times in 2025, requesting that the company stop marketing and distributing the devices. "The safety and effectiveness of the device has not been established," the FDA wrote, adding there are reports of problems including "failure to resolve a choking incident due to lack of suction, bruising around the face, lips, and mouth, and scratches in the back of the throat."
Unconscious victims A choking victim who becomes unconscious must be gently caught before falling and placed lying face-up on a surface. That surface should be firm enough (it is recommended placing a layer of something on the floor and laying the victim above).
Emergency medical services should be summoned, if this has not already been done. It can be also convenient that any rescuer asks for a defibrillator around (an AED, as those devices are commonplace), just in case it can be necessary to treat the victim's heart. The anti-choking cardiopulmonary resuscitation (CPR) for unconscious adults and children is quite similar to any other CPR, but with some modifications: In a first step, a series of 30
chest compressions are applied on the lower half of the
sternum (the bone that is along the middle of the chest from the neck to the belly) at an approximate rhythm of nearly 2 per second. After that series, the rescuer looks for the obstructing object and, if it is already visible, the rescuer makes a
try to extract it, usually by using a finger sweeping (hopefully from the mouth). Normally, the object would be a food bolus (and not the epiglottis, a cartilaginous flap of the throat). It is also possible to try to extract it when it is deeper and not visible, always carefully: using the fingers to take it, or lifting the victim's chin to form a straight way to the throat while the victim is face up (face down in case of the victim's tongue obstructs too much, or on a side with a base under the head) and then grasping or sweeping the stuck object with tools: thin kitchen tweezers, scissors (these used with care), forks and spoons (in a reverse position: introducing their handle) or even a toothpick (if other instruments were too big for the case); however, the protocols do not recommend extracting the obstructing object if it is not visible (a blind extraction), because of the risk to sink it deeper by accident, and because the compressions could move the object outside by themselves (in some cases). Moreover, if any removal is tried and is taking too much time, it may require alternating it with the chest compressions at some moments, without hindering to the extraction. And, whether the object has been found and removed in this step or not, the CPR procedure must pass to the next step and continue until the victims can breathe by themselves or emergency medical services arrive. In the next step of the CPR, it is recommended that the rescuer applies
a rescue breath, pinching the victim's nose and puffing air inside of the mouth. Rescue breaths would usually fail while the obstructing object is blocking the entrance of air. This can be resolved by ''tilting the victim's head
up and down, thus altering the shape of the airway and attempting to open an entrance for the air, and then giving another rescue breath''. After the rescue breaths, this resuscitation returns to the 30 initial compressions, in a cycle that repeats continually, until the victim regains consciousness and breathes, or until the object is extracted. Unconscious choking may lead to cardiac arrest, in which case
defibrillation is needed. It is convenient to ask around for a defibrillator, such as an
AED, to be used on a victim that remains in cardiac arrest after having extracted the stuck object (if it has been extracted, and only after that). An AED is designed to be easy to use by an untrained person by guiding the user with voice instructions.
Finger sweeping It is crucial to avoid blindingly sweeping the airway unless there is direct visualization of the airway – in fact, these procedures are advised only to be performed in more controlled environments such as an operating room. In unconscious choking victims, the American Medical Association has previously advocated sweeping the fingers across the back of the throat to attempt to dislodge airway obstructions. Many modern protocols suggest other treatment modalities are superior. Red Cross procedures also advise rescuers not to perform a finger sweep unless an object can be clearly seen in the victim's mouth to prevent driving the obstruction deeper into the victim's airway. Other protocols suggest that if the patient is conscious they will be able to remove the foreign object themselves, or if they are unconscious, the rescuer should place them in the
recovery position to allow the drainage of fluids out of the mouth instead of down the trachea due to gravity. There is also a risk of causing further damage (inducing vomiting, for instance) by using a finger sweep technique. There are no studies that have examined the usefulness of the finger sweep technique when there is no visible object in the airway. Recommendations for the use of the finger sweep have been based on anecdotal evidence.
Particular cases Infants (babies under 1 year-old) The majority of choking injuries and fatalities occur in children aged 0–4, highlighting the importance for widespread dissemination of the appropriate anti-choking techniques for these age groups. In fact, it has been shown that increased parental education may decrease choking rates among children. For infants under 1 year-old, the American Heart Association recommends adapted procedures. The size of the children's body is the most important aspect in determining the correct anti-choking technique. So the
normal first aid techniques against choking would be tried in children who are too large for the babies' procedures (or they would be tried as a less appropriated attempt if the rescuer is unable to perform the techniques for babies). First aid for choking infants alternates a cycle of special back blows (five back slaps) followed by special chest thrusts (five adapted chest compressions). In the
back blows maneuver, the rescuer slaps on the baby's back. It is recommended that the baby receive them being slightly leaned upside-down on an inclination. There exist several ways to achieve this: According to a widely propagated modality: the rescuer sits down on a seat with the baby, and supports the baby with a forearm and its respective hand. The baby's head must be carefully held with that hand (approximately by the face), and kept in a normal position, facing forward, not inclinated. Then the baby's body can be leaned forward upside-down along the rescuer's thighs, and receive the slaps. As an easier alternative: the rescuer can sit on a bed or sofa, or even the floor, carrying the baby. Next, the rescuer should support the baby's body on the own lap, to lean the baby a bit upside-down at the right or the left of the lap. The baby's head must be in a normal position, facing forward, frontally, and not inclinated. It is always convenient that the baby's chest is supported against something. Then the rescuer would slap the back of the baby. If the rescuer cannot sit down: at least it is possible to attempt the manoeuver at a low height and over a soft surface. Then the rescuer would support the baby with a forearm and the hand of that side, holding carefully the baby's head with that hand (approximately by the face, but always trying that the baby's head keeps in a normal position, facing forward, not inclinated). The baby's body would be leaned upside-down in that position to receive the slaps. In situations with rescuers who cannot do all of that (as rescuers with disabilities and others), they can still try the normal back blows, supporting the baby's chest with one hand, bending the baby's body, and then giving firm slaps with the other hand. In the
chest thrusts manoeuver, the baby's body is placed lying face up on a surface (it can be the rescuer's thighs, lap or forearm). Then, the rescuer does the compressions pressing with only two fingers on the lower half of the bone that is along the middle of the chest from the neck to the belly (on the chest bone, named
sternum, on its part that is the nearest to the belly). Abdominal thrusts are not recommended in children less than one year old because they can cause liver damage. The back blows and chest thrusts are
alternated in cycles of five back blows and five chest compressions until the object comes out of the infant's airway or until the infant becomes unconscious. that alternates compressions and rescue breaths, like in a normal CPR, but with some differences: The rescuer begins by making 30
compressions, pressing, with two thumbs or the heel of one's hand, on the lower half of the bone in the middle of the chest (the
sternum, on its part that is the nearest to the belly), at an approximate rate of nearly 2 per second (100-120 compressions per minute). At the end of the round of compressions, the rescuer looks into the mouth for the obstructing object. And, if it is already visible, the rescuer makes a
try to extract it (usually using a finger sweep). The rescuer must not confuse a foreign object with
epiglottis: a cartilaginous flap of the throat, nor with
uvula: a piece of flesh in the back of the mouth. Current protocols do not recommend attempting to extract the object if it is not visible (a blind extraction) because of the risk to sink it deeper by accident. In total, no more than ten seconds should be spent without doing compressions. If the object cannot be immediately extracted, this CPR procedure must continue to the next action and continue until the babies can breathe by themselves or emergency medical services arrive. In the next step of the CPR, the rescuer makes
a rescue breath, covering the baby's mouth and nose simultaneously with their own mouth, and gently exhaling one time. The goal of a rescue breath is to observe the rise and fall of the chest, indicating that air has reached the lungs. However, one should be careful so as to not overinflate the baby's lungs; a rescuer should not attempt to blow against resistance. After two rescue breaths, the rescuer must return to the 30 initial compressions, repeating the same resuscitation cycle again, continually, until the choking baby regains consciousness and begins to breathe normally, or until emergency help arrives.
Defibrillation may be needed, as a choking infant that is already unconscious can suffer a cardiac arrest at any moment due to hypoxia.
Coughing should be encouraged first before applying the techniques. When the victim cannot cough, it is recommended alternating series of back blows and thrusts, as in other cases. grasping the victim by the legs (behind of the knees, or by the calves or ankles) and rotating them until they are out of the bed. Next, the rescuer would sit the victim up on the edge, pulling the shoulders or arms (in the forearms or wrists). Then it is possible to apply the anti-choking manoeuvers The victim will not have control of their bodily functions and will need someone to create a safe area for them. One should clear a space where the victim can lay down and remove or loosen anything that is around their neck. Then one should turn them on their side as to help them breathe and to avoid potential choking on the saliva.
Self-treatment First aid anti-choking techniques can be applied on oneself if others are not around to perform general first aid. One recommended response consists of positioning ones own abdomen over the border of an object: usually a chair back, but it could work on an armchair, railing or countertop, and then
driving the abdomen upon the border, making sharp thrusts in an inwards-an-upwards direction. It is possible to
place a fist or both fists between the chosen border and the belly, to increase the pressure of the maneuver and make it easier (depending on the situation). It is also possible trying to fall on the edge, aiming to achieve more pressure in that way. Other variation of this consists in pressing one's own belly with an appropriated object, in an inwards-and-upwards direction. Additionally,
abdominal thrusts can be self-applied only with the hands. This is achieved by making a fist, grasping it with the other hand, and placing them on the area located between the chest and the belly button. Then the body is bent forward and the hands make strong compressions pressing in an inwards-an-upwards direction. One study concluded that the self-administered abdominal thrusts were as effective as those performed by another person. When certain scenarios make it impossible for self treatment with abdominal thrust (serious injuries, pregnancy, or obesity), the
self application of chest thrusts is recommended, although more difficult. This would be achieved by leaning the body forward, making a fist, grasping it with the other hand, and doing strong compressions inwards with both of them on the lower half of the chest bone (the
sternum, the bone that crosses vertically the middle of the chest). It is convenient to relax the chest for a better reception. Other variation of this is the use of an appropriated object to press inwards in the same point, being equally convenient to receive the compressions when the chest is relaxed. Making attempts to cough, when it is possible, can also aid in clearing the airway. Alternatively, multiple sources of evidence suggest applying the head-down (inverse) position. Usually, this procedure is only performed by someone with knowledge about it and surgical skills, when the patient is already unconscious. == Prevention ==