While the Heimlich maneuver has been a go-to solution for choking for half-a-century, in the last decade anti-choking or airway clearance devices have grown in popularity, thanks in part to news reports and social media.

Airway clearance devices gained national attention in 2021 after a stranger used a LifeVac device to save a 10-month-old choking at a South Carolina restaurant. In 2023, bodycam video from Ontario, Ohio captured a police officer using a LifeVac on a toddler as the child choked on a toy nail.

The devices are handheld and placed over a victim’s nose and mouth to create suction. The user then pulls a handle up to activate the suction and dislodge an object stuck in a victim’s throat.

There’s now a rising movement across the country to require schools be stocked with airway clearance devices, including in New York City.

Former City Council member Kristy Marmorato led the effort to mandate airway clearance devices in every school building in the city.

Marmorato explained why the issue is personal for her in an interview with NY1.

“30 years ago, we lost my grandfather to choking, a choking event in a restaurant, and they did do a Heimlich maneuver. It was a failed attempt,” Marmorato said.

Before stepping into politics, Marmorato had a 20-year career in healthcare as an x-ray technician. She convinced more than a dozen council members to cosponsor her push to place anti-choking devices in city schools.

The legislation she sponsored quietly passed in December, just before Marmorato’s term in office came to an end. However, the law only takes effect when and if a device receives FDA authorization for use in school-age children during choking emergencies and when there’s formal guidance on using the devices from the American Heart Association or the American Red Cross.

Questions have since surfaced about the science and the sales of airway clearance devices.

Emergency room physician Dr. Darria Long spent time learning about and testing anti-choking devices.

“I am an ER doctor, and I’m a mom. I have three children, so if there is something better to help us with choking, I am all for it,” Long said.

“I did a really deep dive because there is a lot, there are a lot of viral videos about these devices,” she said. “I bought all the devices myself and tried them on myself, as much as you can on yourself, tried them on my children, tried them on my husband.”

“I also really dove into, what is the literature that exists? What are the studies?“ Long added.

What she found wasn’t straightforward.

“There’s not data right now — of human data looking at these that is from independent sources — that is really showing that these devices were more effective than traditional first aid,” Long said. “There are some other studies that have shown potential problems, such as when done in cadavers, they show that after multiple times it can create some swelling.”

The American Red Cross, the American Heart Association and the FDA all advise that if a person is choking, use established protocols like the Heimlich maneuver first and anti-choking devices should only be used as backup if the Heimlich or back blows and chest thrusts aren’t working.

Phil Heimlich has emerged as a vocal critic of anti-choking devices. His father, Dr. Henry Heimlich, created the Heimlich maneuver.

“My father spoke out very strongly against these devices, because, as he explained, when you are choking, you only have four minutes before death or brain damage sets in, and my father specifically warned that going hunting for some device is going to likely cost the life of the person,” Heimlich said.

In February 2025, as the Council weighed mandating airway clearance devices in city schools, the New York State office of Children and Family Services sent a letter to child care programs across the state advising “established rescue protocols do not include anti-choking devices.”

Seven months later, the FDA sent a warning letter directly to LifeVac, writing, “FDA is concerned that your firm’s continued unauthorized marketing and distribution of the LifeVac Rescue Suction Device may put the public health and safety at risk.”

NY1 asked Marmorato if she consulted with any medical authorities while pushing for her legislation.

“I was in the medical field for 24 years. I do have CPR certification, and I do know that the Heimlich maneuver is the first line of defense,” Marmorato responded. “We know that we have something, in addition, that can possibly save someone.”

After years of warnings, in March the FDA issued new guidance authorizing the LifeVac for marketing and distribution as a second-line treatment for choking in the U.S.

Creator Arthur Lih says the change in classification from the FDA did not come overnight.

“Took us two years, intensive scientific data testing, force, cadaver simulation, biostatistician analysis, packaging, everything,” Lih said.

The legislation requiring city schools to stock anti-choking devices has not gone into effect, as the American Red Cross and the American Heart Association are both still weighing the safety of anti-choking devices.

In the meantime, Lih says he’ll focus on the mission of his company, saving lives.

“Get trained, have a LifeVac and we’ll stop one child from dying every five days, and we’ll have a year where no child dies in schools,” Lih said.