CPR for an Unresponsive Choking Victim: What Changed in 2025

The 2025 AHA guidelines introduced the most significant changes to choking management in decades. For the first time, the AHA formally recommends back blows as part of the adult and child choking response. The infant technique was also updated to replace the eliminated two-finger chest thrusts.

If you learned choking response before March 2026, the protocol you practiced has changed. Here is the updated sequence for every age group.

Get trained on the updated choking protocols in our AHA-certified classes.

The New Adult Choking Protocol: Back Blows First

Previously, the AHA recommended abdominal thrusts (the Heimlich maneuver) as the sole intervention for conscious choking adults. The 2025 guidelines now recommend:

1. Stand behind the choking person
2. Deliver 5 back blows between the shoulder blades using the heel of your hand
3. Follow with 5 abdominal thrusts (lean the person forward, place your fist above the navel, grasp with the other hand, and thrust inward and upward)
4. Alternate between 5 back blows and 5 abdominal thrusts until the object is expelled or the person becomes unresponsive

This is the first time the AHA has included back blows in its adult choking guidance. International organizations like the Red Cross and the European Resuscitation Council have recommended back blows for years, and the AHA's inclusion reflects accumulated evidence supporting the approach.

Child Choking Response Now Includes Back Blows Too

For children aged one year to puberty, the protocol mirrors the adult sequence: alternate 5 back blows with 5 abdominal thrusts. Previously, only abdominal thrusts were recommended for this age group.

Adjust the force of both back blows and abdominal thrusts to the size of the child. The mechanics are the same as for adults, just proportionally less forceful.

Infant Choking: Updated Technique

The infant choking response was modified because the two-finger chest thrust technique was eliminated across all AHA protocols:

1. Position the infant face-down on your forearm, supporting the head and jaw
2. Deliver 5 back blows between the shoulder blades using the heel of your hand
3. Turn the infant face-up on your forearm
4. Deliver 5 chest thrusts using the heel of one hand on the lower half of the breastbone
5. Alternate until the object is expelled or the infant becomes unresponsive

The key change is the chest thrust technique: it is now performed with the heel of one hand instead of two fingers. Abdominal thrusts remain contraindicated for infants due to the risk of organ injury.

Learn about all the infant CPR changes in our detailed guide.

When a Choking Victim Becomes Unresponsive

If the choking victim loses consciousness at any point during your intervention, the protocol transitions to standard CPR:

1. Carefully lower the person to the ground
2. Call 911 if not already done
3. Begin CPR starting with compressions (30 compressions for a single rescuer)
4. Before delivering breaths, look into the mouth. If you can see the obstructing object, remove it with a finger sweep. Do not perform blind finger sweeps.
5. Attempt to deliver 2 breaths
6. Continue CPR cycles until EMS arrives

The compressions themselves serve a dual purpose: they circulate blood AND may help dislodge the foreign object through increased intrathoracic pressure.

Review the full compression protocol including rates, depth, and ratios.

Choking Statistics That Underscore the Importance of Training

Choking kills one child every five days in the United States. Over 12,000 children visit emergency rooms annually for food-related choking injuries. Children under five account for 73% of nonfatal choking injuries and 75% of fatalities. Hot dogs are the number one cause of food-related choking death in children three and under.

For adults, choking is the fourth leading cause of unintentional injury death in the United States, with food and other objects causing over 5,000 deaths per year.

These are not rare events. Knowing the correct, current response protocol is a practical skill that everyone should have.

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