The use of the Heimlich maneuver in near drowning: Institute of Medicine report.

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; and (c) the prospect of teaching rescue workers a different protocol than that which is taught at present for resuscitating victims of cardiopulmonary arrest from all causes other than near drowning.(ABSTRACT TRUNCATED AT 250 WORDS)