Statements & reports
by medical & water safety
organizations regarding the use of the
Heimlich maneuver (abdominal thrusts) to
revive near-drowning victims
(Peter)
Heimlich said that the media “have incorrectly
written that there’s a ‘controversy’
associated with the treatment. In fact, in the
medical community, it’s my father vs. everyone
else. That’s not a controversy, that’s one
celebrity doctor -- someone who hasn’t worked
in a hospital since 1976 and has no background
in drowning except for his claims promoting
the Heimlich maneuver -- making unsupported
claims.” (Washington
Post, June 3, 2011)
Per this
article, in June 2012 -- after
almost four decades -- my father's nonprofit
Heimlich Institute finally stopped promoting
the treatment.
Via United
States
Lifeguard Standards: An Evidence-based
review and report by the United States
Lifeguard Standards Coalition
(American Red Cross, United States
Lifesaving Association, YMCA), June 2011:
In the drowning
process resuscitation, upper abdominal
thrusts pose a greater risk of
precipitating gastroesophageal
regurgitation and subsequent aspiration.
Upper abdominal thrusts do not expel
sufficient water from the airway or lungs
to assist in resuscitation. In addition,
upper abdominal thrusts may delay and
complicate the start of effective
cardiopulmonary resuscitation (CPR).
Via the 2010
American Heart Association Guidelines
for Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care Science:
There is no evidence
that water acts as an obstructive
foreign body. Maneuvers to relieve
foreign-body airway obstruction (FBAO)
are not recommended for drowning victims
because such maneuvers are not necessary
and they can cause injury, vomiting,
aspiration, and delay of CPR.
Via
Sub
diaphragmatic Thrusts and Drowning
Victims by the American
Red Cross Advisory Council on First Aid
and Safety (2006):
Studies have shown that
there is no need to clear the airway of
aspirated water. Only a modest amount of
water is aspirated by the majority of
drowning victims and it is rapidly
absorbed into the central circulation.
Therefore, it does not act as an
obstruction in the trachea (Institute of
Medicine Report (Rosen, Stoto, &
Harley, 1995). It has also been shown
that some victims do not aspirate fluid
because they develop laryngospasm or
experience breath-holding (Modell,
1993). An attempt to remove water from
the breathing passages by any means
other than suction (e.g., abdominal
thrusts or the Heimlich maneuver) are
unnecessary and potentially dangerous
(Institute of Medicine Report, Rosen
Stoto, & Harley, 1995).
The routine use of abdominal
thrusts for drowning victims is not
recommended.
Via
The
Ship’s Medicine Chest and First Aid
at Sea, US Department of
Health and Human Services Public Health
Service, Office of the Surgeon General
(2003):
In clearing the
airway prior to CPR, do not perform
the Heimlich maneuver! The Heimlich
maneuver has no role in drowning
resuscitation, unless a solid foreign
body obstructs the airway (this does
not mean water or vomit) and
ventilation is otherwise
impossible.
Via
The
Use of the Heimlich Maneuver in Near
Drowning: Institute of Medicine Report
by Peter Rosen MD, Michael Stoto PhD, and
Jim Harley MD, The Journal of Emergency Medicine,
The Journal of Emergency Medicine, Vol 13,
No 3, pp 397-405, 1995:
The application of the
Heimlich maneuver as the initial and
perhaps only step for opening the airway
in all near-drowning victims has been
proposed by Henry Heimlich and Edward
Patrick, contrary to current
resuscitation guidelines for the
treatment of near-drowning victims
established by the Emergency Cardiac
Care (ECC) Committee of the American
Heart Association. Although the Heimlich
maneuver is useful for the removal of
aspirated solid foreign bodies, there is
no evidence that death from drowning is
frequently caused by aspiration of a
solid foreign body that is not
effectively treated by the current ECC
recommendations. Furthermore, the
evidence is insufficient to support the
proposition that the Heimlich maneuver
is useful for the removal of aspirated
liquid. Moreover, because there is no
evidence to support Heimlich's
hypothesis that substantial amounts of
water are aspirated by near-drowning
victims or that such aspirated liquid
causes brain damage and death, the
available evidence does not support
routine use of the Heimlich maneuver in
the care of near-drowning victims. The
routine use of the Heimlich maneuver for
treatment of near drowning raises
several concerns: (a) the amount of time
it would take to repeat this maneuver
and how long this would delay the
initiation of artificial ventilation;
(b) possible complications of the
Heimlich maneuver, especially if the
near drowning is associated with a
cervical fracture; and (c) the prospect
of teaching rescue workers a different
protocol than that which is taught at
present for resuscitating victims of
cardiopulmonary arrest from all causes
other than near drowning.
Via International
Life Saving Federation Medical
Commission to address lifeguard
questions about the value of using
abdominal thrust to revive
drowning/near drowning victims
(1998):
The Medical
Commission of the International Life
Saving Federation has carefully
considered the particular problems of
upper airway management in near
drowning. Techniques which have poor
efficacy and purely anecdotal support
are strongly discouraged.
Abdominal thrusts (Heimlich Maneuver) to
relieve airway obstruction have been
carefully considered and the following
conclusions drawn:
*
In near drowning upper abdominal thrusts
pose a great risk of precipitating
gastro-oesophageal regurgitation and
subsequent inhalation of stomach contents
into the lungs.
*
There is no clear medical rationale for
its use and in particular it seems clear
that the manoeuvre cannot expel
sufficient water from the lower portions
of the respiratory tree to aid in
resuscitation.
*
There are no well controlled blind
studies to validate its value in near
drowning.
*
The use of abdominal thrusts as a first
maneuver will merely serve to delay the
institution of appropriate
cardiopulmonary resuscitation which has
been well proven to save life in this
condition.