From Abdominal Thrusts to Adaptive Pressure Pulse Systems for Self-Rescue in Foreign-Body Airway Obstruction
Foreign-body airway obstruction (FBAO) can deteriorate within minutes and remains an important cause of preventable hypoxic injury. Current first-aid practice relies mainly on back blows and abdominal thrusts, yet the result of these maneuvers may vary with rescuer performance, the timing of intervention, and patient factors. The problem is more difficult when choking occurs without an available bystander. Alongside conventional self-administered maneuvers, suction-based airway clearance devices have therefore attracted attention, although the supporting clinical evidence is still limited. A further concept is to individualize abdominal compression so that the applied pressure is sufficient to generate an expulsive airflow without exposing the patient to avoidable injury. This review discusses current clinical management, the physiological basis and limitations of abdominal thrusts, evidence for emerging self-rescue approaches, and the safety and research requirements of adaptive pressure strategies. At present, these newer approaches should be viewed as investigational or adjunctive rather than replacements for guideline-recommended care.
[1] Igarashi Y, Norii T, Nakanishi H, et al., 2026, Airway Obstruction Time and Outcomes After Foreign Body Airway Obstruction: A Nationwide Prospective Cohort Study From the MOCHI Registry. Resuscitation, 220: 111002.
[2] Norii T, Igarashi Y, Yoshino Y, et al., 2024, The Effects of Bystander Interventions for Foreign Body Airway Obstruction on Survival and Neurological Outcomes: Findings of the MOCHI Registry. Resuscitation, 199: 110198.
[3] Kleinman M, Buick J, Huber N, et al., 2025, Part 7: Adult Basic Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 152(Suppl 2): S448–S478.
[4] Couper K, Abu Hassan A, Ohri V, et al., 2020, Removal of Foreign Body Airway Obstruction: A Systematic Review of Interventions. Resuscitation, 156: 174–181.
[5] Igarashi Y, Norii T, Nakae R, et al., 2025, Efficacy of Abdominal Thrusts and Back Blows for Patients With Foreign Body Airway Obstruction: MOCHI Registry Analysis. Resuscitation Plus, 25: 101016.
[6] Pavitt M, Swanton L, Hind M, et al., 2017, Choking on a Foreign Body: A Physiological Study of the Effectiveness of Abdominal Thrust Manoeuvres to Increase Thoracic Pressure. Thorax, 72(6): 576–578.
[7] Soroudi A, Shipp H, Stepanski B, et al., 2007, Adult Foreign Body Airway Obstruction in the Prehospital Setting. Prehospital Emergency Care, 11(1): 25–29.
[8] Saccomanno S, Saran S, Coceani Paskay L, et al., 2023, Risk Factors and Prevention of Choking. European Journal of Translational Myology, 33(4): 11471.
[9] Lee S, Kim S, Shekherdimian S, et al., 2009, Complications as a Result of the Heimlich Maneuver. Journal of Trauma, 66(3): E34–E35.
[10] Dunne C, Peden A, Queiroga A, et al., 2020, A Systematic Review on the Effectiveness of Anti-Choking Suction Devices and Identification of Research Gaps. Resuscitation, 153: 219–226.
[11] Dunne C, Viguers K, Osman S, et al., 2023, A 2-Year Prospective Evaluation of Airway Clearance Devices in Foreign Body Airway Obstructions. Resuscitation Plus, 16: 100496.
[12] Paludi M, Palermo N, Limonti F, et al., 2025, A Systematic Review on Suction-Based Airway Clearance Devices for Foreign Body Airway Obstruction. International Emergency Nursing, 79: 101575.
[13] Galarreta-Aperte S, Domínguez-Vías G, González-Díaz A, et al., 2026, Efficacy of Antichoking Suction Devices Versus Traditional Techniques: A Systematic Review and Meta-Analysis. Journal of Emergency Nursing, 52(3): 742–753.e3.
