Critical Care Clinics
Volume 13 • Number 3 • July 1997
Copyright © 1997 W. B. Saunders Company
Department of Pediatrics, University of Florida Health Science Center, Jacksonville (LKD, MOG, NK) Wolfson Children's Hospital, Jacksonville (NR) the Nemours Children's Clinics (LKD, MES, MOG, NK) the Department of Medicine, University of Florida College of Medicine, Gainesville (JLF) the Department of Emergency Medicine, Orlando Regional Medical Center, (JLF) Arnold Palmer Hospital (MES), Orlando, Florida
Management at the Scene (EXCERPTED)
Maneuvers to empty the lungs of water, such as the Heimlich maneuver or other postural drainage techniques, are of unproven benefit and CPR should not be delayed in order to perform these techniques.
Orlowski [85] reported that a 10-year-old boy who was retrieved from the pool and given abdominal thrusts (Heimlich maneuver) while in a supine position with his head turned to the side vomited profusely after the maneuver. This interfered with the adequacy of mouth-to-mouth resuscitation. The child developed aspiration pneumonia, respiratory distress syndrome with pneumomediastinum, and right and left pneumothoraces. After a 3-week course, the child was discharged in a persistent vegetative state. Because approximately 74% of human drowning victims have been reported to aspirate vomitus, it is possible that this child would have vomited irrespective of a particular therapy. This report stresses the temporal relationship of emesis to the Heimlich maneuver. Of course, if airway obstruction with a foreign body is suspected, these maneuvers may be life-saving. We recently cared for a 3-year-old near-drowning victim who developed severe aspiration pneumonia following a bystander-administered Heimlich maneuver that resulted in regurgitation of stomach contents while the patient was still unconscious. Neurologic recovery was complete, but the patient succumbed to acute respiratory failure despite extracorporeal membrane oxygenation. The Heimlich Institute continues to promote the Heimlich maneuver as effective therapy for near-drowning victims in cardiac arrest. This visible campaign in the lay press has kept the issue somewhat controversial despite the consensus among most expert panels that there is currently no database on which to recommend postural drainage techniques.
Hypoxemia in near drowning is common, so mouth-to-mouth or mouth-to-nose ventilation must be commenced promptly. [13][64] Although the Heimlich maneuver has been suggested prior to the initiation of rescue breathing in the near-drowned victim, [44] there is no evidence that these victims aspirate substantial amounts of water. [70] In addition, this maneuver may increase the risks of other injuries. [104] If there is inadequate chest movement when ventilation is attempted, the standard procedure to position and clear the child's airway should be implemented. When available, supplemental oxygen should be given to all submersion victims as soon as possible. Victims of diving accidents or unwitnessed near drownings in which head or neck trauma is likely should have cervical spine precautions taken to minimize movement of the neck. External cardiac compressions should be administered if the rescuer is unable to palpate a pulse.
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