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Choking on a foreign body: a physiological study of the effectiveness of abdominal thrust manoeuvres to increase thoracic pressure
  1. Matthew J Pavitt,
  2. Laura L Swanton,
  3. Matthew Hind,
  4. Michael Apps,
  5. Michael I Polkey,
  6. Malcolm Green,
  7. Nicholas S Hopkinson
  1. NIHR Respiratory Biomedical Research Unit, Royal Brompton Hospital and Harefield NHS Foundation Trust and Imperial College, London, UK
  1. Correspondence to Dr NS Hopkinson, Royal Brompton Hospital, Fulham Rd, London SW3 6NP, UK; n.hopkinson{at}


The Heimlich manoeuvre is a well-known intervention for the management of choking due to foreign body airway occlusion, but the evidence base for guidance on this topic is limited and guidelines differ. We measured pressures during abdominal thrusts in healthy volunteers. The angle at which thrusts were performed (upthrust vs circumferential) did not affect intrathoracic pressure. Self-administered abdominal thrusts produced similar pressures to those performed by another person. Chair thrusts, where the subject pushed their upper abdomen against a chair back, produced higher pressures than other manoeuvres. Both approaches should be included in basic life support teaching.

  • Respiratory Measurement

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  • Twitter Follow Matthew Pavitt @DrMattPav; Nicholas Hopkinson @COPDdoc

  • Contributors NSH, MG, MH and MIP conceived the study. MG, MP, LS, MA and NSH performed experiments and collected data. MP and LS analysed the results and produced the first draft of the paper to which all authors contributed, and all authors have approved the final version.

  • Funding The study was supported by the NIHR Respiratory BRU at Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, who part fund MIP's salary.

  • Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. NSH affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Competing interests None declared.

  • Ethics approval Imperial College Joint Research Office and Health Research Authority.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Requests for anonymised individual patient data can be made to the corresponding author.

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