From Heimlich to a Smarter Choking Response
American Heart Association (AHA)Updates: 2020 vs. 2025
Mr Salman Sabir
Emergency Medical Services
College of Health Science
Choking can happen anywhere - at lunch with friends, during a college event, or even at home. A split-second decision in such a moment can mean the difference between life and death. That's why the AHA updates the guidelines periodically (every 5 years), and the latest one was released in October 2025, replacing the 2020 version.
2020 Guidelines
The approach in the 2020 guidelines recommends using the abdominal thrust (Heimlich maneuver) for responsive adults & children till the obstruction is relieved or the adults & children become unresponsive. For infants, administer five back blows followed by five chest thrusts using the two-finger method until the obstruction is relieved or the infant becomes unresponsive. If the choking victim becomes unresponsive (all age groups), begin Cardiopulmonary Resuscitation (CPR) with one modification from standard CPR: before giving rescue breaths, open the mouth and look for a visible foreign body. If an object is seen, remove it carefully. If nothing is visible, do not perform a blind finger sweep.
2025 Guidelines - More unified
This guideline has simplified the choking management in all age groups
• For the first time, the guidelines provide a specific choking response for conscious adults: repeatedly alternate five back blows with five abdominal thrusts (the Heimlich maneuver) until the obstruction is cleared or the person becomes unresponsive. This sequence was not included for adults in the pre-2025 guidance.
• For children, the principle is the same — alternating back blows and abdominal thrusts are recommended, replacing the older practice that emphasized abdominal thrusts alone.
• For infants, five back blows with five chest thrusts using the heel of one hand until the airway is clear or the infant becomes unresponsive.
The choking victim becomes unresponsive, guidelines remain the same as in 2020 — begin CPR with one modification from standard CPR: before giving rescue breaths, open the mouth and look for a visible foreign body. If an object is seen, remove it carefully. If nothing is visible, do not perform a blind finger sweep.
These changes bring a consistent approach across ages - back blows first, followed by thrust according to the victim's size and anatomy. The latest scientific evidence shows that combining back blows and thrusts increases the chance of removing the object from the airway. It also acknowledges that the use of the Heimlich maneuver alone to manage choking victims increases the chance of injury.
By unifying response steps and teaching a clear algorithm (Back blows - Thrust - Repeat), the 2025 guidelines make it easier for laypersons and trained responders alike to act confidently in an emergency.
