Clinical Notes : Resuscitation

97. Choking - Adult and Child over 1 year old


Some countries have a survival rate following out of hospital cardiac arrest of 5% while other countries have a survival rate

as high as 30%. 

Countries with the best outcome have raised national cardiac arrest awareness and have embedded Chain of Survival in their emergency response protocols, so that more bystanders and first responders are able to deliver effective CPR.


In out-of-hospital cardiac arrest, ALS care (Advanced Life Support) is associated with increased ROSC (Return of Spontaneous Circulation), but is not associated with greater functional outcome than BLS care alone .


BLS choking adult and child over 1 year old


Universal signal for choking:
patient has both hands wrapped around the base of their throat.



Get the adult/child’s attention and ask them if they are choking.

Assess for signs and symptoms of airway obstruction.

  • Partial airway obstruction

    • may result in stridor or a high-pitched audible noise during respiration

    • may allow for a productive cough or allow the patient to speak

  • Complete airway obstruction

    • the adult/child is unable to speak, cry, or provide any sounds of respiration

    • the adult/child may be confused, weak, obtunded, or cyanotic​



If partial airway obstruction:

  • Do not attempt Heimlich maneuver

  • Encourage cough

  • watch closely for progression to complete airway obstruction


If complete airway obstruction, and conscious adult/child:

  • Send someone to call the emergency response team

  • If alone:

    • immediately call the emergency response team.

    • Attempt Heimlich maneuver:

      • Stand directly behind the child/adult

      • Place both of your arms around the child/adult’s waist

      • Make a fist with one hand and grab the fist with opposite hand

      • Position the thumb end of the fisted hand immediately above the patient’s navel (ample distance away from the xiphoid process)

      • Perform fast upward and inward diaphragmatic abdominal thrusts

      • Continue abdominal thrusts until the obstruction is removed


If adult/child becomes unconscious:

  • Carefully support the adult/child to the ground

  • Immediately activate (or send someone to activate) EMS

  • Initiate CPR

  • After 2 minutes, if someone has not already done so, the healthcare provider should activate the emergency response system

  • Before attempting rescue breaths during normal CPR, assess the airway, removing any visually present obstruction

  • ​Simply looking into the mouth should not significantly increase the time needed to attempt the ventilations and proceed to the 30 chest compressions.

  • Do not use a blind finger sweep in an attempt to remove an obstruction




If abdominal thrusts are not effective, the rescuer may consider chest thrusts


Chest thrusts should be used for obese patients if the rescuer is unable to encircle the victim’s abdomen.

If the choking victim is in the late stages of pregnancy, the rescuer should use chest thrusts instead of abdominal thrusts.

2015 to 2020

Chest thrust

Abdominal thrust

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Guidelines for CPR & Emergency Cardiovascular Care

American Heart Association

Updated November 2017


Highlights of the 2015 American Heart Association Guidelines Updates for CPR and ECC



Resuscitation Council; UK

Adult basic life support and automated external defibrillation


ERC Guidelines 2015

European Resuscitation Council


Advanced vs. Basic Life Support in the Treatment of Out-of-Hospital Cardiopulmonary Arrest in the Resuscitation Outcomes Consortium.

Kurz et al

Resuscitation. 2018 Jul;128:132-137


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