In a significant update to emergency medical advice, the American Heart Association (AHA) is now recommending that people use back blows as the first response to aid someone who is choking, moving away from the long-standing practice of starting with the Heimlich maneuver.
Calgary Research Drives Guideline Change
The revised guidelines, updated for the first time since 2010, are based on compelling evidence from a study conducted at the University of Calgary's O'Brien Institute for Public Health. The research team, led by emergency physician Dr. Cody Dunne, analyzed three years of data from Alberta's emergency medical services, focusing on incidents where people choked and called 911.
"We compared how successful the different interventions were... and which ones were safer and more effective," explained Dr. Dunne. "And what we found out was that back blows were more successful at relieving the object compared to abdominal thrust and chest compressions."
How to Perform the New Recommended Technique
The new protocol calls for a clear sequence of actions. First, ensure the choking person is standing and can lean forward. Dr. Dunne cautions not to intervene until signs of severe obstruction appear, such as an inability to cough, cry out, or make sound.
When action is required:
- Position the person leaning forward as close to a 90-degree angle as possible, supporting their chest with one arm.
- Using the heel of your other hand, deliver five firm strikes between the person's shoulder blades.
- If the object is not dislodged, then switch to abdominal thrusts (the Heimlich maneuver). Place a fist just above the navel, grasp it with your other hand, and perform five quick, upward thrusts.
- Alternate between five back blows and five abdominal thrusts until the blockage is cleared or the person can breathe again.
Special Considerations for Children and Infants
The guidelines also provide specific advice for younger victims. For children, kneel to their level to perform back blows. For babies under one year old, hold them face-down along your forearm in a football-like hold, supporting the head, and deliver back blows. For infants, chest compressions are recommended instead of abdominal thrusts.
Dr. Dunne noted that while the AHA reviews choking and CPR guidelines every five years, there was previously scant evidence on the effectiveness of back blows. "At the time, abdominal thrusts were thought to be the best just because they had the most data," he said. The accumulation of new research, including the Calgary study, prompted this critical review and the resulting update to official life-saving recommendations.
