Saturday, August 13, 2011

SCOOP! (I think): Canadian Red Cross catches up with the rest of the world, makes backblows the first treatment for choking - but are they still behind the curve?

(Based on some quick Googling, I think this a scoop. But if you know of a previous media report, e-mail it to me and I'll give credit where it's due.) 

After years of lagging behind the rest of the world, the Canadian Red Cross (CRC) is finally updating their choking rescue guidelines.

Hey, I didn't say it - they did:
In many countries, the combination of back blows and abdominal thrusts has been used since the 2005 guidelines. In North America, using only abdominal thrusts was decided upon as it was easier for the lay rescuer to remember, not due to supporting evidence. Evidence now supports the combination of techniques as more successful than using only one method.

More from a CRC statement published last October:
Airway obstruction – for adults and children (one year or older), if the person shows signs of mild airway obstruction, encourage continued coughing but do nothing else. If he or she shows signs of severe airway obstruction and is conscious, apply up to five back blows. If this fails, give up to five abdominal thrusts. If the obstruction is still not relieved, continue alternating five back blows with five abdominal thrusts.
So why is Canada late to the dance? I don't know, but for decades, most of the world's first aid organizations have recommended backblows as the first treatment response.

Here's another question. Why did the CRC decide to continue to teach abdominal thrusts (a/k/a the Heimlich maneuver) rather than chest thrusts, the preferred treatment in Australia and New Zealand?

The Aussies have a straightforward explanation for their position:
Stephen Dean, Assistant CEO, St John Ambulance Australia's 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."
That argument certainly seems to be backed up this information: 
For conscious (choking) victims, case reports have shown success in relieving FBAO (Foreign Body Airway Obstruction) with any one of several techniques, including back blows/slaps, abdominal thrusts and chest thrusts. Frequently, more than one technique is needed to relieve the obstruction. However, there have been reported life-threatening complications associated with the use of abdominal thrusts.
...Severe complications from the use of this technique have been cited in the medical literature. Desaiet al. reported a case of traumatic dissection and rupture of the abdominal aorta after a forceful Heimlich maneuver. In addition to this complication, these authors cite reports of other complications occurring with the use of the Heimlich maneuver. These injuries include retinal detachment, rib fractures, and ruptures of abdominal organs. Additional injuries included rupture of the diaphragm, jejunum, liver, esophagus and stomach. Other reported injuries of vascular structures consisted of aortic stent graft displacement, rupture of the aortic valve, acute aortic regurgitation, laceration of a mesenteric vessel, and acute aortic thrombosis in both an aneurysmal and non-aneurysmal aorta.
The above is from the 2011 international first aid and resuscitation guidelines of the International Federation of Red Cross and Red Crescent Societies.

Now take another look at this sentence from the CRC statement posted at the top of this item:
In North America, using only abdominal thrusts was decided upon as it was easier for the lay rescuer to remember, not due to supporting evidence.
Am I missing something or is this a rationale for continuing to teach a potentially life-threatening procedure simply because they don't want to take on the job of re-training the population? 

An enterprising reporter could certainly ask the CRC to provide the supporting evidence that persuaded them to continue recommending abdominal thrusts rather than switching to chest thrusts.