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Via the posted comments under Detainee dies after choking on food in Saitama police station cell, Japan Today, November 5, 2018: 

Janet Heimlich Nov. 8 05:15 pm JST



Peter M. Heimlich Nov. 9 01:12 am JST

I caught a factual error and a half-truth in my sister Janet Heimlich's post. I've also posted links to a first-rate 2009 Australian Broadcasting documentary re: the history of our father's namesake anti-choking treatment and a thought-provoking recent blog item by a U.S. cardiologist.

The American Heart Association (and most first aid agencies worldwide) recommend back blows as an effective treatment for responding to a choking emergency. More via this page on my website http://tinyurl.com/hnuxyxs "One study shows that back blows can drive an object deeper into the throat."

Janet -- a former journalist who edited our dad's 2014 memoir http://tinyurl.com/yau8h6nd -- is presumably referring to the now-tainted study by the late Richard Day L. MD et al of Yale published by the journal Pediatrics in 1982.

Research by my wife Karen M. Shulman and me revealed that our dad, the late Henry J. Heimlich MD, clandestinely funded the study.

Prior to 2005, AHA guidelines included citations of the Day study. That year I shared our research with Jerry Potts, PhD, Director of Science at the AHA's ECC Programs. The citation has not appeared in subsequent AHA guidelines.

Because of the Yale connection, I also shared our research with veteran medical reporter Abram Katz at the New Haven Register which resulted in this 10/23/06 report http://tinyurl.com/zvesjs9

Also see this 6/7/82 thank-you letter from dad to Dr. Day which I obtained from the Yale archives http://tinyurl.com/j3n8jbk "The Heimlich manoeuvre" by Aviva Ziegler, Australian Broadcasting Corporation, 7/27/09 http://tinyurl.com/y92fwr6w "A Call To Reconsider The Heimlich Experiment: Let’s Scientifically Determine The Best Approach To Choking Victims" by Anthony Pearson MD, The Skeptical Cardiologist (Dr. Pearson's blog), 8/15/18 http://tinyurl.com/ybnxkqvs 


BelCanto Nov. 9 12:26 pm JST

I'm liking where this comment section is going! 


Peter M. Heimlich Nov. 13 10:51 am JST

Via Facts About ACEP and Emergency Medicine:

The American College of Emergency Physicians (ACEP) is the oldest and largest national medical specialty organization representing physicians who practice emergency medicine. With more than 32,000 members, ACEP is the leading continuing education source for emergency physicians and the primary information resource on developments in the specialty.

...The College continually monitors trends in the health care environment and analyzes issues affecting emergency physicians and their patients.

So why does ACEP recommend a choking rescue treatment that is not recommended by the American Heart Association, the American Red Cross, or the International Liaison Committee on Resuscitation (ILCOR)?

The treatment?

Performing the Heimlich maneuver on unconscious choking victims.

Via ACEP's website and their booklet entitled What To Do in a Medical Emergency:


My layman's understanding is that the Heimlich maneuver (aka abdominal thrust) creates an artificial cough so that a choking victim may cough out a solid foreign body stuck in their throat.

But if you're unconscious, you can't cough, right?

Also, and I may have missed something, to my knowledge there is no published research that supports the treatment.

But I have no medical training and I'm just an amateur researcher.

If a prominent emergency medicine organization like ACEP recommends a medical treatment, presumably they have their reasons.

In an attempt to learn those reasons, for the past week I've sent multiple e-mails to ACEP representatives at their Dallas headquarters trying to get answers to these questions:

1) Approximately when did ACEP begin recommending abdominal thrusts (the Heimlich maneuver) as an effective treatment for unconscious choking victims?

2) Please explain the basis for that treatment recommendation, including citations to relevant published research.

I've gotten multiple confirmations of receipt, but not even a courtesy reply.

Rather than chase the organization, today I sent this letter to the commissioner of the Texas health commissioner requesting that he ask ACEP to answer my questions. (Click here to download a copy.)

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Also see my May 28, 2013 item, What's the U.S. Surgeon General's recommendation for treating choking victims? I can't get an answer, so my congressman Rob Woodall is trying to find out.







Note: After posting, I changed the headline of this item -- PMH

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From Abdominal Thrust, a Helena, Montana TV news report that aired yesterday:

In tonight's your Health Report, Beartooth NBC’s Jessica Hoppe shows how to perform the Heimlich Maneuver properly and why it's so important....This year April 8 through April 14 is designated as National Heimlich Maneuver Week to celebrate the technique and educate others about it.

Based on this newspaper article last year, it's unlikely the celebration will ever catch on in the land down under (emphasis/asterisk added).

As the assistant CEO of St John Ambulance Australia's Queensland branch, it has been (Stephen Dean's) job to teach and train people across the resuscitation industry.

He proved his devotion to teaching and developing resuscitation techniques when he became a member of the Australian Resuscitation Council (ARC) 21 years ago.

In that time, Stephen has been involved in developing guidelines, policies and training materials for the council of which he is now chairperson for the Queensland branch.

..."In the US, they still advocate the Heimlich Manoeuvre for choking but in Australia, we believe the evidence shows it is dangerous* and so our guidelines don't promote it," Stephen said.

Aviva Ziegler (source)

And from Aviva Ziegler's "Heimlich manoeuvre" audio documentary, first aired by the Australian Broadcasting Corporation in July 2009, and which you owe it to yourself to check out because it's terrific (emphasis/asterisks added):

Aviva Ziegler: (You) might be shocked to learn that the Heimlich manoeuvre appears to have never been accepted practice in Australia. We are one of the only countries in the world where it's not officially on the books. This is a typical Australian first aid training course held by the St John Ambulance.

Trainer: The learning outcomes for this session is we should be able to firstly identify a person who is choking, if somebody is gagging with something partially obstructed in the upper airway we should ask the person to relax and encourage them to cough. Our research has been proven on a conscious casualty a good cough is generally better than anything else. Now if the good cough is not effective we then have to hit that person, we give them what we call back slaps, he's leaning forward, in the centre of the shoulder blades in an upwards direction I would give him five nice solid slaps. If that is unsuccessful we should place a hand in the centre of the back on the sternum and we just press down sharply five chest thrusts and if that is unsuccessful we alternate between the two.

...Aviva Ziegler: As you will hear later, the assertion that back slaps are dangerous is probably only in Dr Heimlich's mind. But anecdotally it seems that the Heimlich manoeuvre can save lives. So if we are the only country not using it, who's right, them or us? Professor Ian Jacobs from the University of Western Australia is Chair of the Australian Resuscitation Council and a member of the International Liaison Committee in Resuscitation.

Professor Ian Jacobs (source)

 Ian Jacobs: There is actually very little or no evidence to support the Heimlich manoeuvre and the literature is awash with reports of harm and this includes things such as fractured sternums, ruptured livers and other serious consequences of this Heimlich manoeuvre.*

 ...Apart from a few case reports there is no other evidence to support what Henry Heimlich has advocated. There's no published data of any substantial nature except for a few case reports and lots of TV programs and there were substantial reports in the literature of harm.

Trainer: A question that often comes up in our courses is to why we don't do the Heimlich manoeuvre in Australia. So are you all aware of that where they get that sort of a bear hug squeeze from behind? OK, the reason it's not taught is the simple fact that research conducted here in Australia and also overseas has proven that it can be dangerous because there's a risk of damaging internal organs such as the spleen, the liver, pancreas etc.* We follow the policy statements as laid down by the Australian Resuscitation Council, they are saying that if there was any clinical evidence to prove that it was effective they'd put a policy on it and we would have it in our book. Any other questions?

*  

Note: A previous version of this item included the case report articles in a different format. I changed it to this embedded Scribd document for ease of updating.

From Basic first aid may save a life by Bianca Clare, Sunshine Coast Daily (Australia), April 4, 2011:

Darryl Clare is not surprised that a new survey has found one in three people have no idea how to administer first aid. The St John Ambulance first aid training officer says "Dr Google" and Hollywood blockbuster movies are increasingly misleading the public on what to do when things go wrong.

"The most common mistake made is thinking the Heimlich manoeuvre is the best way to treat someone who is choking," he said. " This is incorrect. The correct method is to give the patient five back blows between the shoulder blades.

"The Heimlich manoeuvre has been widely criticised, even by the founder's son.

"It can work it some cases, but it can lead to serious consequences...even death."

The survey revealed 36% of 1134 respondents would immediately think of the Heimlich manoeuvre when someone was choking.

From worksheet for 2010 ILCOR Evidence-Based Review of Science for Emergency Cardiac Care (p.7-8):

Case reports of complications from abdominal thrusts

Agia GA, Hurst DJ. Pneumomediastinum following the Heimlich maneuver. JACEP. 1979;8:473-475.

Ayerdi J, Gupta SK, Sampson LN, Deshmukh N. Acute abdominal aortic thrombosis following the Heimlich maneuver. Cardiovasc Surg. 2002;10:154-156.

Bintz M, Cogbill TH. Gastric rupture after the Heimlich maneuver. J Trauma. 1996;40:159-160.

Chapman JH, Menapace FJ, Howell RR. Ruptured aortic valve cusp: a complication of the Heimlich maneuver. Ann Emerg Med 1983; 12: 446-448.

Cowan M, Bardole J, Dlesk A. Perforated stomach following the Heimlich maneuver. Am J Emerg Med. 1987;5:121-122.

Croom DW. Rupture of stomach after attempted Heimlich maneuver. Jama. 1983;250:2602-2603.

Desai SC, Chute DJ, Desai BC, Koloski ER. Traumatic dissection and rupture of the abdominal aorta as a complication of the Heimlich maneuver. J Vasc Surg 2008; 48: 1325-1327.

Drinka P. TBroken ribs following CPR or the Heimlich maneuver. J Am Med Directors Association 2009;10:283-284.

Dupre MW, Silva E, Brotman S. Traumatic rupture of the stomach secondary to Heimlich maneuver. Am J Emerg Med. 1993;11:611-612.

Feeney SN, Pegoli W, Gesting ML. Pancreatic transection as a complication of the Heimlich maneuver: case report and literature review. J Trauma 2007; 62: 252-254.

Feldman T, Mallon SM, Bolooki H. Fatal acute aortic regurgitation in a person performing the Heimlich maneuver. N Engl J Med; 1986; 315: 1613.

Gallardo A, Rosado R, Ramirez D, Medina P, Mezquita S, Sanchez J. Rupture of the lesser gastric curvature after a Heimlich maneuver. Surg Endosc. 2003;17:1495.

Haynes DE, Haynes BE, Yong YV. Esophageal rupture complicating Heimlich maneuver. Am J Emerg Med 1984; 2: 507-509.

Kirshner RL, Green RM. Acute thrombosis of abdominal aortic aneurysm subsequent to Heimlich maneuver: a case report. J Vasc Surg. 1985;2:594-596.

Lee SL, Kim SS, Shekherdimian S, Ledbetter DJ. Complications as a result of the Heimlich maneuver. J Trauma 2009;66:E34-E35.

Mack L, Forbes TL, Harris KA. Acute aortic thrombosis following incorrect application of the Heimlich maneuver. Ann Vasc Surg. 2002;16:130-133.

Majumdar A, Sedman PC. Gastric rupture secondary to successful Heimlich manoeuvre. Postgrad Med J. 1998;74:609-610.

Martin TJ, Bobba RK, Metzger R, Madalina M, Bollu M, Patel BG, Kazemi MM. Acute abdominal aortic thrombosis as a complication of the Heimlich maneuver. J Am Geriatr Soc 2007; 55: 1146−1147.

Meredith MJ, Liebowitz R. Rupture of the esophagus caused by the Heimlich maneuver. Ann Emerg Med. 1986;15:106-107.

Nowitz A, Lewer BM, Galletly DC. An interesting complication of the Heimlich manoeuvre. Resuscitation 1998;39:129--131.

Olenchock SA, Rowlands DM, Reed JF, Garzia FM, Zasik JM. Dysphagia after Heimlich maneuver. Chest 2004; 125: 302-304.

Orlowski JP. Vomiting as a complication of the Heimlich maneuver. JAMA. 1987;258:512-513.

Palleiro MMO, López CB, Pretel MCF, Fernández JS Hepatic rupture after Heimlich maneuver. Annal Emerg Med 2007; 49: 825-826.

Rakotoharinandrasana H, Petit E, Dumas P, Vandermarcq P, Gil R, Neau JP. [Internal carotid artery dissection after Heimlich maneuver]. Ann Fr Anesth Reanim. 2003;22:43-45.

Rich GH. Pneumomediastinum following the Heimlich maneuver. Ann Emerg Med. 1980;9:279-820.

Roehm EF, Twiest MW, Williams RC. Abdominal aortic thrombosis in association with an attempted Heimlich maneuver. JAMA. 1983;249:1186-1187.

Tung PH, Law S, Chu KM, Law WL, Wong J. Gastric rupture after Heimlich maneuver and cardiopulmonary resuscitation. Hepatogastroenterology. 2001;48:109-111.

Ujjin V, Ratanasit S, Nagendran T. Diaphragmatic hernia as a complication of the Heimlich maneuver. Int Surg. 1984;69:175-176.

Valero V. Mesenteric laceration complicating a Heimlich maneuver. Ann Emerg Med. 1986;15:105-106.

van der Ham AC, Lange JF. Traumatic rupture of the stomach after Heimlich maneuver. J Emerg Med. 1990;8:713-715.

Visintine RE, Baick CH. Ruptured stomach after Heimlich maneuver. JAMA. 1975;234:415.