Heimlich Maneuver & Drowning

[scubadog]

After a week of rescue training, and we covered quite a few scenarios. I found an article written by a nurse in a local free sheet. She is giving advice on drowning, with the beaches being full of holiday makers. Not sure where her figures are from, but she states...¨That as many 42% of drowning victims will die if given CPR only, a much lower figure of 3% will die if given the Heimlich Maneuver first¨.
She also mentions that there is a large amount of disagreement in the medical profession, first aid and emergency paramedics about the maneuver.
But if those figures are accurate, theres a big difference in the number of survivors. Has it ever been mentioned during diver training ?

[recurve]

Although no longer a practicing paramedic, this makes a deal of sense. The Heimlich is used to remove an obstruction from the airway by forcing the diaphragm up, and a trachea-full of water is just another obstruction. It would seem reasonable that you are more likely to produce succesfull results from the CPR if the airway is clear.

That said, in 15 years on the ambulance service, I only ever saw one successfull resuscitation using CPR.

I would be interested in the source of her figures however, as it strikes me that we may well be looking at a very small 'population' on which these results are based.

[Houseplant]

Not sure. Once water gets into the trachea, it's free to travel down the bronchi, bronchioles and into the alveoli (this is where gas exchange takes place), although the Heimlich manoeuvre might eject some water from the respiratory tract, it's doubtful that water would be removed from this critical area.

Also, found this in a respectable journal:

Journal of Emergency Medicine. 13(3):397-405, 1995 May-Jun.
The application of the Heimlich maneuver as the initial and perhaps only step for opening the airway in all near-drowning victims has been proposed by Henry Heimlich and Edward Patrick, contrary to current resuscitation guidelines for the treatment of near-drowning victims established by the Emergency Cardiac Care (ECC) Committee of the American Heart Association. Although the Heimlich maneuver is useful for the removal of aspirated solid foreign bodies, there is no evidence that death from drowning is frequently caused by aspiration of a solid foreign body that is not effectively treated by the current ECC recommendations. Furthermore, the evidence is insufficient to support the proposition that the Heimlich maneuver is useful for the removal of aspirated liquid. Moreover, because there is no evidence to support Heimlich's hypothesis that substantial amounts of water are aspirated by near-drowning victims or that such aspirated liquid causes brain damage and death, the available evidence does not support routine use of the Heimlich maneuver in the care of near-drowning victims. The routine use of the Heimlich maneuver for treatment of near drowning raises several concerns: (a) the amount of time it would take to repeat this maneuver and how long this would delay the initiation of artificial ventilation; (b) possible complications of the Heimlich maneuver, especially if the near drowning is associated with a cervical fracture…..

[recurve]

Well that looks pretty well thought out. I did wonder if broncho-spasm would have closed off the lower airways when water headed that way. It is not a field I know a great deal about. Most of the folks I dealt with as 'near drowning' were drowning on their own body secretions

I think the point is well made that getting in fast with CPR is perhaps the best bet on a rapidly steepening slippery slope. There are plenty of bods on the beach that I wouldn't fancy trying to get into a position to give a Heimlich to if they were unconscious. Time spent doing that would probably have been more productively used on CPR.

[Houseplant]

Originally Posted by recurve

Well that looks pretty well thought out. I did wonder if broncho-spasm would have closed off the lower airways when water headed that way.

That's a good point, around 10 - 15 % patients undergo sustained laryngospasm and no water ever enters their lungs.

Originally Posted by recurve

Most of the folks I dealt with as 'near drowning' were drowning on their own body secretions

While we're at it, there's not much of a case for in-water resuscitation, in fact it might do more harm than good since it delays access to more effective management. Certainly, if I found myself on the surface with an unconscious diver, I'd have a hard think about the best course of action depending on specific circumstances.

[recurve]

I might be tempted to stick a working reg in their gob, pinch their nose and do little pushes on the purge. Getting them onto a hard surface for chest comps may be what they need, but getting them onto such a surface could be a couple of minutes away, and just about ANYTHING you can do if they are not breathing is going to be a hell of a lot better than nothing.

It's like I tell people who might have to do CPR, you WILL break ribs, get used to the idea, even punching a hole in the lung with a broken rib end while you are trying is giving them a lot more hope than if you stood back and did diddly squat.

[Houseplant]

Originally Posted by recurve

It's like I tell people who might have to do CPR, you WILL break ribs, get used to the idea, even punching a hole in the lung with a broken rib end while you are trying is giving them a lot more hope than if you stood back and did diddly squat.

Totally agree, if you come across someone who is (clinically) dead, you can't make matters worse! However, as you intimated in the previous post, the success rate of CPR is very small.

[Twinset & Wing]

am i right in thinking that by the success rate you are talking about tne amount of people that are resucitated directly by CPR and not the people that are benifited by using defibs e.t.c after CPR??

[recurve]

Success with a defib was almost as small. Quite frankly, unless someone is doing CPR almost from the moment of arrest, then the window of opportunity for medical intervention is not sufficiently long to allow for the chain of events to get a medic to the scene.

Shopping centers, airports et all recognise this and have defibs close at hand, and plenty of people who have been trained to do CPR. Note that in a crisis, many such people fail to act and the outcome is poor.

Places like Seattle teach the whole population in giving CPR, the upshot of which there is likely to be at least ONE bystander who has the wit to do something.

In my book, you could train most eight year olds to do life support CPR, even if it was just the chest compressions (which has been shown to be quite effective), and it should be part of the national curriculum.

YMMV

[Houseplant]

Recurve is spot on, I think the figure banded about is that mortality increases by 10% for every minute that CPR/AED is delayed post-cardiac arrest.

CPR + AED increases short-term survival by around 60% versus CPR alone, however, 60% of not very much, is err, not very much.

Best advice is lay off the pies