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USE OF HEIMLICH MANEUVER MAY NOT ALWAYS BE WISE

The American Red Cross and the Heimlich Institute still don't see eye-to-eye about how to use mouth-to-mouth resuscitation for near-drowning victims.

Famous for his technique, which has saved countless choking victims, Dr. Henry J. Heimlich, president of the Heimlich Institute at Xavier University in Cincinnati, has maintained since 1986 that the Heimlich maneuver, an abdominal upward and inward thrust, should be used on all unconscious drowning victims before mouth-to-mouth resuscitation is attempted.He estimated 500 lives a year can be saved by the widespread use of his maneuver at beaches and pools. He believes the maneuver clears water out of the lungs, and makes standard lifesaving techniques, like mouth-to-mouth and CPR, more effective.

Several independent organizations have analyzed the maneuver's effectiveness for near-drowning situations, arriving at different conclusions.

The Institute of Medicine, a branch of the National Academy of Sciences, convened a special independent committee at the request of the Emergency Cardiac Care Committee. After reviewing the data about the use of the "Heim-lich maneuver" for near-drowning victims, the committee disputed Heimlich's assertions. Its findings were released Aug. 9.

"This is contrary to current resuscitation guidelines for the treatment of near-drowning victims established by the Emergency Cardiac Care Committee of the American Heart Association," the committee's executive summary said.

It said while the Heimlich maneuver is useful for removing solid foreign bodies from the lungs, there is no evidence to support the conclusion that Heimlich maneuver is useful in removing liquid from the lungs. It concluded that an abdominal thrust should be performed "only after ventilation (air forced into the lungs) has been shown to be ineffective and then only to remove a solid foreign body."

The American Red Cross, which offers first-aid training but is not a medical research organization, bases its guidelines and training on the recommendations of the ECC.

Heimlich disputes the findings of the special committee and ECC.

"The reason they (the ECC) had this study done is because I proved to them their previous study was flawed," Heimlich said. "I expected it. I've felt, for a long time, the Heimlich maneuver should be used before starting CPR because in near-drowning situations, too much water gets into the lungs for them to fill with air using artificial resuscitation."

He said using the maneuver first will save many lives.

"While bureaucrats procrastinate and call for more animal studies (to test the Heimlich maneuver's effectiveness), lives will be lost," Heimlich said.

He cited a study that concluded the maneuver saved 87 percent of pulseless, non-breathing drowning victims, compared to 28 percent using only mouth-to-mouth and CPR.

"The knee-jerk call for more animal experiments will result in thousands of pointless deaths," Heimlich said. "In some instances, animal studies have contributed, but they have been overdone. More animal studies would be excessive and cruel and contribute nothing."

The Physicians Committee for Responsible Medicine has waded into the controversial waters and sided with Heimlich. The committee released its latest statement Aug. 18.

"The Heimlich maneuver has already saved so many lives," said Dr. Neal Barnard, president of PCRM. "It should be part of standard procedure in treating drowning victims. More cruel dog-drowning experiments won't tell us anything we don't already know."

Dr. Peter Rosen, director of the Emergency Medicine Residency Program and professor of Clinical Medicine and Surgery, Division of Emergency Medicine, University of California, San Diego, was the chairman of the special committee with the Institute of Medicine that reviewed the question.

"Our recommendation was the Heimlich maneuver should be used only if the (drowning) victim didn't respond to mouth-to-mouth resuscitation," Rosen said. "We said the maneuver was a benefit for solid foreign objects. But you cannot remove large amounts of water from the lungs with the Heimlich maneuver."

He said he saw no benefit to using the procedure and opposed any delay in starting mouth-to-mouth resuscitation.

"It's a waste of time," he said. "Our professional ethics dictate that if there is no benefit to do no harm."

Rosen said he has "great respect for Dr. Heimlich. I think he's doing some wonderful work."

Twenty years ago, Dr. Harry Gibbons, who then served as the director for Salt Lake City and County Health Department, was instrumental in educating Utahns about the Heimlich maneuver. He promoted the maneuver's use with television, radio and newspaper advertisements, making Salt Lake the first city to promote the maneuver on a city-wide basis.

Gibbons has entered the fray - in Heimlich's camp.

"In my opinion, we've got a great local Red Cross," he said. "But the National Red Cross is like the federal government bureaucracy. They want animal studies, which I think is dumb."

Gibbons said the Red Cross usually is about 10 years behind Utah when implementing innovative first-aid techniques.

"For example, we in Utah gave up back slaps in 1975 because the technique probably drives the foreign object farther down," he said. "The Red Cross took 12 more years to give it up. It's only a matter of time when they will endorse and teach the Heimlich maneuver as a necessary step for all near-drowning situations."