Ichikawa Michitaro, Oishi So, Mochizuki Katsunori, Nitta Kenichi, Okamoto Kazufumi, Imamura Hiroshi
Department of Emergency and Critical Care Medicine Shinshu University School of Medicine Matsumoto Japan.
Acute Med Surg. 2017 Jul 17;4(4):418-425. doi: 10.1002/ams2.297. eCollection 2017 Oct.
To study the most effective body position for Heimlich maneuver.
A choking simulation manikin was connected to a laryngeal model of a child or an adult, and a differential pressure transducer recorded the airway pressure and waveform during the maneuver. A konjac jelly was placed on the larynx to mimic complete supralaryngeal obstruction. The maneuver (five successive compressions) was carried out six times each in standing, prone, and supine positions. For cases of children, we added a supine position with a pillow under the back.
In the adult model, airway obstruction was more frequently relieved in the supine and prone positions than in the standing position ( < 0.001). In the child model, airway obstruction was more frequently relieved in the supine position, with a pillow, and in the prone position, than in the standing position ( < 0.001). Without relief, successive Heimlich maneuvers made the airway pressure increasingly negative (adult, from -21.9 ± 6.5 cmHO to -31.5 ± 9.1 cmHO in the standing position [ < 0.001]; child, from -15.0 ± 9.5 cmHO to -30.0 ± 9.2 cmHO in the standing position [ < 0.001] and from -35.0 ± 17.4 cmHO to -47.3 ± 25.1 cmHO in the supine position without a pillow [ = 0.002]).
The Heimlich maneuver was more effective in the supine and prone positions. In children, the prone position may be most effective. Successive Heimlich maneuvers may be harmful when the airway is not relieved after the first compression.
研究海姆立克急救法最有效的身体姿势。
将模拟窒息的人体模型与儿童或成人的喉部模型相连，在急救过程中，一个压差传感器记录气道压力和波形。在喉部放置魔芋胶以模拟完全性喉上梗阻。分别在站立位、俯卧位和仰卧位进行该急救法（连续五次按压），每种体位各进行六次。对于儿童病例，我们增加了一种在背部下方垫有枕头的仰卧位。
在成人模型中，仰卧位和俯卧位比站立位更常解除气道梗阻（<0.001）。在儿童模型中，有枕头的仰卧位和俯卧位比站立位更常解除气道梗阻（<0.001）。若未解除梗阻，连续进行海姆立克急救法会使气道压力越来越负（成人，站立位时从-21.9±6.5 cmH₂O降至-31.5±9.1 cmH₂O[<0.001]；儿童，站立位时从-15.0±9.5 cmH₂O降至-30.0±9.2 cmH₂O[<0.001]，无枕头仰卧位时从-35.0±17.4 cmH₂O降至-47.3±25.1 cmH₂O[=0.002]）。
海姆立克急救法在仰卧位和俯卧位更有效。对于儿童，俯卧位可能最有效。首次按压后气道未解除梗阻时，连续进行海姆立克急救法可能有害。
