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The Heimlich Maneuver and the Resuscitation of Near-Drowning Victims
Abstract
To the Editor.—
The Heimlich maneuver is now taught by the American Red Cross and American Heart Association as a method for saving near-drowning victims.1A partial review of near-drowning literature by Dr Ornato2 includes a section, "The Need to Clear the Airway of Water With a Heimlich Maneuver." By selectively excluding data from references, it minimizes the pathophysiological significance of aspirated water and the effectiveness of the Heimlich maneuver in expelling that water from the airway and lungs.3Initially, the article acknowledges "terminal gasping with flooding of the lungs." Its table shows that 85% of near-drowning victims weighing 68 kg (150 lb) aspirate as much as 1.5 L of freshwater (<22 mL/kg), and 15% even more; in saltwater, 59% aspirate up to 750 mL (<11 mL/kg), 25% aspirate 750 to 1500 mL, and 16% aspirate more. These volumes are up to ten times greater than the
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EACH year, 3,900 healthy individuals in the United States strangle because of food stuck in their throats (New York Times Magazine, June 16, 1974, p 10). The actual incidence is probably much higher, as indicated by a report of unsuspected food-choking found at postmortem examinations of three patients thought to have died from myocardial infarction in one nursing home last year.1 Food-choking is the sixth leading cause of accidental death—its victims number more than those accidentally killed by firearms or in airplane accidents. This article describes experimental studies and the clinical evaluation of a simple maneuver that prevents these food-choking fatalities.
Food-choking can be recognized easily. The victim cannot speak or breathe; he becomes pale, then deeply cyanotic, and collapses. Because death is sudden (occurring in four to five minutes), the episode is sometimes confused with a myocardial infarction, although the signs and symptoms of the two are different. The
DROWNING causes almost 9000 deaths in the United States each year out of an estimated 80 000 near-drowning incidents.1 Males between the ages of 10 and 19 years are the most common victims. Fortunately, only about one of every nine or ten underwater submersion accidents results in death. When death occurs, the term "drowning" is applied. "Near-drowning" is the term used when there is at least temporary survival from suffocation by submersion.2
The usual sequence of events in the animal model of drowning is initial breath holding followed by the swallowing of large amounts of water, vomiting, terminal gasping with flooding of the lungs, and death.3 Animal models of near-drowning in the laboratory do not precisely mimic human drowning in natural waters.4-6 This must be taken into account when extrapolating results of animal research to clinical resuscitation. Less hemodilution is noted in humans than in animals
The Schafer artificial respiration method, which compressed the lungs to expel water, was abandoned in 1958 when mouth-to-mouth ventilation became the primary resuscitation method. Water thus remained in the lungs, making mouth-to-mouth ineffectual for treating drowning. Subdiaphragmatic pressure (Heimlich Maneuver) effectively evacuates water from the lungs by elevating the diaphragm and compressing the lungs. The method is safe because it eliminates compression of the rib cage. The first step in resuscitating a drowning person should be subdiaphragmatic pressure repeated until water ceases to flow from the mouth.