Thursday, December 4, 2014

"The Heimlich" has never been recommended in Australia "because it can be dangerous." But the American Heart Association recommends it as the best treatment. Who's got it right?

Via The Right Way to Stop Choking by Daniela Ongaro, The Daily Telegraph (Australia), October 29, 2014:

Although popularised by Hollywood, the manoeuvre (invented by American physician, Dr Henry Heimlich in the 1970s and introduced in the US) has never been accepted practice in Australia.

The Australian Resuscitation Council in its June 2014 guidelines states: “Life-threatening complications associated with use of abdominal thrusts have been reported in 32 case reports.

“Therefore, the use of abdominal thrusts in the management of Foreign Body Airway Obstruction is not recommended. Instead back blows and chest thrusts should be used.”

St John’s Ambulance First Aid trainer Nick Allison says Australian resuscitation experts do not recommend the Heimlich, which has attracted significant controversy for the risks it poses and the lack of scientific evidence supporting its use.

“The Heimlich manoeuvre looks dramatic, which is why you see it in all the movies,” Allison says.

“It came out in the US but there were concerns because of the damage being caused (to victims) such as broken ribs and the difficulty involved in using it if the choking person was a larger person.

“It’s not a recommended technique because it can be dangerous.”

Via the Dallas-based American Heart Association's most recent Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science (2010), chair: Robert A. Berg MD, Professor of Anesthesiology and Critical Care at the Hospital of the University of Pennsylvania and the Children's Hospital of Philadelphia (emphasis added):

Although chest thrusts, back slaps, and abdominal thrusts are feasible and effective for relieving severe FBAO in conscious (responsive) adults and children ≥1 year of age, for simplicity in training it is recommended that abdominal thrusts be applied in rapid sequence until the obstruction is relieved.

Simplicity in training?

What about science-based evidence?

Via CPR research: Increasing survival after cardiac arrest, Discovery's Edge (the Mayo Clinic's Online Research Magazine), November 2011:

Roger D. White, M.D., an anesthesiologist who favors button-down shirts and ties, has saved countless lives through groundbreaking work in cardiac resuscitation at Mayo Clinic in Rochester, Minn...(Many) of Dr. White's published findings have been incorporated into the American Heart Association (AHA) resuscitation guidelines....

Via A New Maneuver - the circular history of a lifesaving procedure by Pamela Mills-Senn, Cincinnati Magazine, April 2007:

(In) a 2004 e-mail to Peter Heimlich (who corresponded with White using a pseudonym), White is significantly less blase about Dr. (Henry) Heimlich's role. "There was never any science here," White wrote. "Heimlich overpowered science all along the way with his slick tactics and intimidation, and everyone, including us at the AHA, caved in."