Debate surrounds use of Heimlich in drownings

Maneuver beats CPR as first step in saving life, originator contends

August 22, 1999|By Diana K. Sugg | Diana K. Sugg,SUN STAFF

What do you do when someone is drowning?

Many people think first of CPR. Few think of the Heimlich maneuver.

But its inventor believes hundreds of lives could be saved if more people knew that the few steps they use to stop someone from choking can also rescue a drowning victim.

"It's a natural thing to do. You can't get air in water-filled lungs," said Dr. Henry J. Heimlich, 79, a former thoracic surgeon who has also devised other medical concepts that saved thousands of people. The maneuver forces air out of the lungs, which carries the water out with it, he said. Then the person can begin to breathe.

"When I think of all these people dying unnecessarily," he said, "I just can't stand it."

But in a running, 15-year debate, much of the medical establishment says he is wrong. Or at least, he can't prove he is right.

Those who disagree have varied reasons: that a person can indeed breathe with water in the lungs, that the Heimlich might injure the person, and that it might cause a victim to vomit and then swallow the material, blocking the airway. They also say there isn't enough evidence in favor of changing the longtime practice of performing CPR first.

"The maneuver is really a wonderful maneuver and has unquestionably saved lives," said Dr. Solbert Permutt, a professor and expert in respiratory and circulatory physiology at the Johns Hopkins School of Medicine. "But he [Heimlich] just was crazy from our point of view in relation to his notions about this."

Permutt also sat on the 1994 National Academy of Sciences expert panel that concluded the Heimlich maneuver shouldn't be used routinely in drowning cases.

Review planned

The dispute crops up again next month, when the American Heart Association, at an international meeting convened every six years, will review the entire field of cardiac care and resuscitation.

Drowning, which kills about 4,000 Americans a year, is a leading cause of accidental death -- especially among children. For every fatality, there are anywhere from two to 20 near-drownings. The AHA and American Red Cross recommend giving "two slow breaths" in mouth-to-mouth resuscitation; if that doesn't work because the airway seems blocked, rescuers are to try the Heimlich maneuver.

Dr. Nisha Chandra-Strobos, professor of medicine at Hopkins and a former chair of the AHA's basic life support subcommittee, said there is limited data to prove which is better, "but what data there is supports the conventional use of CPR."

But Heimlich points to his review of more than 400 scientific papers on the treatment of drowning to make his case. One 10-year study in Seattle reported that in the presence of lifeguards, 42 percent of children treated with CPR at public swimming pools died. He believes that's because many had water in their lungs.

The Cincinnati-based Heimlich has convinced one key person: the head of a company that trains lifeguards for 95 percent of the nation's water parks and hundreds of pools and other facilities, including Six Flags America in Largo, Md.

Ellis & Associates, based just outside Houston, educates its lifeguards to do the Heimlich maneuver first. Since 1995, the company's lifeguards have used the Heimlich to resuscitate more than 120 people found unconscious and not breathing.

"Something is happening here. The result is very good," said Lawrence D. Newell, a longtime paramedic who teaches other medics. He has collected 1998 data from Ellis' facilities. Of 36 cases in which the Heimlich was used as initial treatment, 29 of the people immediately began to breathe.

`Nobody knows'

Physicians, and Newell, say this data is only anecdotal.

"Nobody can say whether these 36 people wouldn't have been saved by any other alternative method," Newell acknowledged. He thinks rapid response might be the key, and adds: "The reality is nobody knows."

Like so much in emergency medicine, no one has studied which method is better. That's because it's difficult, if not impossible, to test various treatments on patients who are unconscious or dying.

"There is far more literature on cosmology and acupuncture than there is on all of pre-hospital care in emergency medicine," said Dr. Robert R. Bass, executive director of Maryland Institute for Emergency Medical Services Systems.

He said organizations like the AHA and Red Cross have made their decisions based on a careful review of what data they have, not politics, and that they must first be sure not to harm the public.

"Until somebody comes up with some good science," Bass said, "I think this debate is going to go on."

But the answers are critical for many. Switching the order of the treatments -- cardiopulmonary resuscitation and the Heimlich -- involves only a matter of seconds, but doctors say it could determine whether someone lives or dies.

Family tragedy

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