Heimlich Manoeuvre

The Heimlich manoeuvre is used for the removal of airways obstruction in a choking patient. The Heimlich manoeuvre is an emergency technique for preventing suffocation when a victim's airway becomes blocked. It can be used safely on both adults and children, but is not recommended for infants less than 1 year old. It can also be self-administered.

The role of the Heimlich manoeuvre in near drowning is controversial due to the risk of gastro-oesophageal regurgitation and subsequent inhalation of stomach contents.¹ The Medical Commission of the International Life Saving Federation regards near drowning as an absolute contraindication to the Heimlich manoeuvre, unless a solid foreign body is present in the upper airway and cannot be dislodged by other means.

See separate articles on resuscitation. The following sequence is also suitable for use in children over the age of 1 year.

• If the victim shows signs of mild airway obstruction:
  • Encourage him to continue coughing, but do nothing else.
• If the victim shows signs of severe airway obstruction and is conscious:
  • Give up to five back blows.
    • Stand to the side and slightly behind the victim.
    • Support the chest with one hand and lean the victim well forwards so that when the obstructing object is dislodged it comes out of the mouth rather than goes further down the airway.
    • Give up to five sharp blows between the shoulder blades with the heel of your other hand.
    • Check to see if each back blow has relieved the airway obstruction. The aim is to relieve the obstruction with each blow rather than necessarily to give all five.
  • If five back blows fail to relieve the airway obstruction give up to five abdominal thrusts (see Heimlich manoeuvre below).
    • Stand behind the victim and put both arms round the upper part of his abdomen.
    • Lean the victim forwards.
    • Clench your fist and place it between the umbilicus (navel) and the bottom end of the sternum (breastbone).
    • Grasp this hand with your other hand and pull sharply inwards and upwards.
    • Repeat up to five times.
  • If the obstruction is still not relieved, continue alternating five back blows with five abdominal thrusts.
• If the victim becomes unconscious:
  • Support the victim carefully to the ground.
  • Immediately call an ambulance.
  • Begin cardiopulmonary resuscitation.

Adults

• If the person is conscious and standing, first ask them to bend forward and cough. If this fails:
  • Stand behind them.
  • Put your arms around his abdomen, mid-way between umbilicus and xiphoid process (not on the xiphoid process or over the lower rib cage).
  • One hand makes a fist, with the thumb against the abdomen. The other hand grasps the fist of the first hand.
  • With a sharp movement of the hands presses up and into the abdomen, to dislodge the foreign body.
• With a foreign body in the airway of an unconscious patient, compressions should be performed instead of the Heimlich manoeuvre.³ However the method for performing the Heimlich manoeuvre in an unconscious patient is:
  • The manoeuvre can be performed with the casualty lying on their back.
  • Sit astride the unconscious victim (above the knees) and place the heel of a hand in the upper abdominal area below the xiphoid process.
  • Repeated thrusts may be needed.
  • Sweep the mouth with a finger to remove the foreign body.

Children

• The Heimlich manoeuvre can be used in older children.
• The Heimlich manoeuvre should not be performed on small children. Back blows (use the heel of the hand to strike forcefully between the scapulae, with the patient leaning forwards) or chest thrusts should be used instead.

• If the procedure is performed too vigorously, damage to the sternum, liver or stomach may occur.⁴
• Thrombosis of the abdominal aorta is also a rare complication.⁵

• Standard chest compressions:
  • The unconscious victim is placed supine and the hand is placed over the sternum similar to that used for cardiac compression. 6 to 10 thrusts may be necessary to dislodge a foreign body.
  • Should be used, instead of the Heimlich manoeuvre, for pregnant or extremely obese patients.
  • May be more effective, by producing higher peak airways pressure, than the Heimlich manoeuvre for the management of complete airway obstruction by a foreign body in an unconscious patient.⁶
• Blind finger sweeps:
  • In adults, a foreign body may also be removed by sweeping the index finger along the cheek through the mouth and pharynx after the tongue and lower jaw have been displaced forward (tongue-jaw lift).
  • Care should be taken not to dislodge the foreign body further into the airway.
  • Additional finger sweeps and manual abdominal thrusts may be required to dislodge the foreign body completely or to relieve the blocked airway.
  • Progressive hypoxaemia may relax the throat muscles; finger sweeps frequently dislodge a supralaryngeal foreign body after initial attempts have failed.
  • Blind finger sweeps are not recommended in children or infants. But the obstructing object should be carefully removed if it can be seen clearly.