Basic airway management

Evaluation

Conscious

If the patient is conscious symptoms of airway obstructions may include:

• The person cannot speak or cry out or has difficulty doing so
• Breathing, if possible, is labored, producing gasping or stridor.
• The person has a violent and largely involuntary cough, gurgle, or vomiting noise. However, people with complete airway obstruction will have a limited or nonexistent ability to produce these symptoms since they require at least some air movement.
• The person desperately clutches their throat or mouth, or attempts to induce vomiting by putting their fingers down their throat.
• If the airway is not restored, the person's face, lips, or gums turn blue (cyanosis) from lack of oxygen.

Treatment

Treatment includes several procedures aiming at removing foreign bodies from the airways. Most modern protocols, including those of the American Heart Association, American Red Cross and the European Resuscitation Council, recommend several stages, designed to apply more pressure increasingly. Basic treatment includes several procedures aiming at removing foreign bodies from the airways. Most protocols recommend encouraging the victim to cough, followed by hard back slaps, and if none of these things work; abdominal thrusts (Heimlich maneuver) or chest thrusts. Some guidelines recommend alternating between abdominal thrusts and back slaps.

Encouraging the victim to cough

This stage was introduced in many protocols as it was found that many people were too quick to undertake potentially dangerous interventions, such as abdominal thrusts, for items that could have been dislodged without intervention. Also, if the choking is caused by an irritating substance rather than an obstructing one, and if conscious, the patient should be allowed to drink water on their own to try to clear the throat. Since the airway is already closed, there is very little danger of water entering the lungs. Coughing is normal after most of the irritants have cleared, and at this point, the patient will probably refuse any additional water for a short time.

Back blows

Most protocols recommend encouraging the victim to cough, followed by hard back slaps with the heel of the hand on the victim's upper back. The number to be used varies by training organization but is usually between five and twenty. For example, the European Resuscitation Council and the Mayo Clinic recommend five blows between the shoulder blades. The back slap uses percussion to create pressure behind the blockage, assisting the patient in dislodging the article. Other recommendations only use back blows for patients less than one-year-old, alternating between five back blows and five chest thrusts.

Abdominal thrusts

Performing abdominal thrusts involves a rescuer standing behind a patient and using their hands to exert pressure on the bottom of the diaphragm. This compresses the lungs and exerts pressure on any object lodged in the trachea, hopefully expelling it. The European Resuscitation Council and the Mayo Clinic recommend alternating between 5 back slaps and 5 abdominal thrusts in severe airway obstructions. While UpToDate recommends only using abdominal thrusts in adults and children more than one-year-old. In some areas, such as Australia, authorities believe there is not enough scientific evidence to support the use of abdominal thrusts, and their use is not recommended in first aid. Instead, chest thrusts are recommended. A person may also perform abdominal thrusts on himself by using a fixed object such as a railing or the back of a chair to apply pressure where a rescuer's hands would normally do so. As with other forms of the procedure, internal injuries may result.

Chest thrusts

If the patient can not receive pressure on the abdomen, the abdominal thrusts are replaced by chest thrusts. This is the case of pregnant women, obese people, and others. Chest thrusts are applied in the same manner as abdominal thrusts, but pressing inwards on the lower half of the sternum (the chest bone). As a reference, the zone of pressure of the chest thrusts in women would be normally higher than the level of the breasts. The pressure is not focused against the endpoint of the chest bone (which is named the xiphoid process), to avoid breaking it.

Finger sweep

The finger sweep should only be used if a foreign body is easily identified, a blind finger sweep should never be used. In the unresponsive patient receiving CPR, if a solid foreign body becomes visible it should be removed.

Anti-choking devices

In modern times, some commercial anti-choking devices (LifeVac, Dechoker, Lifewand, Willnice) have been developed and released to the market. They do not require electricity to work. The devices use a mechanical vacuum effect instead. Some choking cases where anti-choking devices were employed have appeared in the media.

Critics of the anti-choking devices

In 2023, a fresh cadaver study (a Caucasian male, 175 cm tall) was conducted using saltine crackers, grapes, and cashews. The DeChoker caused severe tongue trauma and failed to relieve the obstruction in all attempts. The LifeVac successfully removed barium-moistened saltine crackers but failed to remove all other foreign bodies. Both devices exerted significant pressure on the tongue. With the exception of the LifeVac saltine cracker, all attempts were completely unsuccessful in facilitating foreign body aspiration. Furthermore, both devices can cause significant pressure and trauma to the oral cavity in clinical settings. The authors concluded that non-physicians should continue to follow the International Committee on Resuscitation guidelines to help facilitate foreign body aspiration.

In 2024, the Resuscitation Council of Great Britain (RCUK) did not recommend the use of foreign body suction devices as standard care for choking. Reasons: There is insufficient clinical evidence that such devices are effective or safe for use in cases of choking. Standard first aid techniques—back blows, abdominal thrusts (Heimlich maneuver), and chest compressions—remain recommended and proven. Suction devices should only be used as a last resort when all standard methods have failed, and only by trained individuals. The use of such devices should not replace basic first aid training. The RCUK has called for further independent research to assess the effectiveness and safety of these devices without banning them.

A 2025 pilot study on cadavers showed that the effectiveness of the LifeVac was extremely low, with only 1 successful attempt in 21 (≈4.8%). Failures were attributed to poor mask fit (especially in edentulous cadavers), insufficient pressure, and anatomical limitations of the model.

That same year, Forbes reported how a business couple made $5 million selling the banned medical device Dechoker on Amazon, despite FDA warnings about its dangers and lack of evidence of effectiveness. The FDA officially banned the sale of Dechoker in the United States due to the lack of clinical evidence of its effectiveness and health risks, especially in children. Despite the ban, the device continued to be actively promoted as a “lifesaver,” with emotional videos and positive reviews. Legal documents show that sellers were aware of the ban but circumvented it by using third-party accounts and changing product descriptions. The medical community criticizes such actions as unethical and dangerous, as they can create a false sense of security in parents.

The LifeVac choking device is also currently under scrutiny due to FDA warnings regarding its unauthorized marketing and safety concerns, but it has not been officially recalled. FDA issued a warning letter to LifeVac LLC on September 18, 2025, stating that the LifeVac Rescue Suction Device is being marketed without the necessary premarket approval. The FDA classifies this device as a Class III medical device, which requires rigorous testing and approval before it can be sold to consumers. The FDA has expressed concerns that the continued marketing of LifeVac could jeopardize public health and safety, as the device's safety and effectiveness have not been established.