The Heimlich Manouevre- why don’t we use it?

The Heimlich Manouevre- why don’t we use it?

Firstly, what exactly is the Heimlich Manouevre?
Dr. Henry Heimlich, born February 20th,1920 in Delaware, U.S.A, is a retired chest surgeon. He is renowned for inventing the emergency management technique of choking- the ‘Heimlich Manoeuvre’ (also known as an ‘abdominal thrust’.) This technique involves a bystander attempting to dislodge a foreign body in a person’s airway by administering a forceful thrust to the area between the sternum and the navel, upward and inward against the diaphragm.
However, there is controversy surrounding this technique- which we shall look at here- and even more controversial are Heimlich’s claims for the efficacy of the Heimlich Manoeuvre not only for choking, but for drowning, asthma and cystic fibrosis.
You may have seen the Heimlich Manoeuvre (HM) on screen- (remember in Mrs. Doubtfire?) It looks dramatic, simple and effective. On the Heimlich website, it is claimed that Ronald Reagan, Elizabeth Taylor, Goldie Hawn, Walter Matthau, Carrie Fisher and Jack Lemmon all had the HM performed on them.

So why wouldn’t Australia be teaching this life-saving technique for choking?

In a nutshell, the risks of the HM appear to outweigh the benefit- especially when there is a more effective way of dislodging the object with less risk of causing harm in the process.
Reported injuries sustained as a direct result of the HM include gastric rupture, lacerated liver, fractured Xiphoid process/sternum, aspiration of stomach contents and other serious complications (see references below). In Australia, back blows and chest thrusts are used for a complete obstruction. (A ‘complete obstruction is when the patient is not talking and not breathing as the result of a choke- in the case of a ‘partial obstruction’- where the patient can speak and is coughing, no intervention is used except possibly a call to 000).

CRITICS

In 2009, the Australian ABC Radio National program’s Health Report, produced and presented by Dr. Norman Swan, examined how a medical procedure such as this one becomes so widely adopted without any serious scientific evidence. In the case of the HM, Dr. Swan describes how “charisma, power and public opinion can override science.” This report is well worth the listen, as it gives a thorough overview of the events surrounding and after the 1974 introduction of the HM.

Ian Jacobs is the Professor of Resuscitation and Pre-hospital Care at the University of Western Australia; Clinical Services Director for St. John Ambulance in W.A; and Chair of the Australian Resuscitation Council. Professor Jacobs says there is little to no evidence of the efficacy of the HM, and significant evidence of harm.

Dr. James Orlowski, Chief of Paediatric Intensive Care at the University of Tampa, Florida, is also highly critical of Dr. Heimlich; “He’s a very dynamic individual, he’s charismatic which is why he’s been able to get as far as he has without ever using any scientific data……I was shocked to find out that Dr. Heimlich had put a lot of political pressure on these committees (American Heart Association and American Red Cross) but had never actually presented any scientific data that the HM even worked in choking. So as far as I know there has never been any worthwhile scientific study of the HM for choking, drowning or any other indication.” (Dr. Heimlich also advocates for the use of the Heimlich Manoeuvre for drowning victims.)
Dr. Orlowski has gathered case studies of people harmed by the HM and as a result has also called on colleagues to conduct studies to examine its efficacy in chokings and drownings. He says that when Dr. Heimlich heard about Orlowski’s call for more research, Dr. Heimlich approached PETA (People for Ethical Treatment of Animals) who subsequently obstructed laboratories where the research was to be held.

Anaesthetist Dr. Charles Guildner, a former member of the United States Cardiac Care Committee when the HM was first put forward by Dr. Heimlich, initially thought the idea of using abdominal thrusts to dislodge foreign material in a choking victim was a good one. He decided to test its efficacy against chest thrusts, using six anaesthetised volunteers. He found that chest thrusts performed significantly better- they produced greater airway pressure than the HM.
Dr. Guildner says that when he reported these results to Dr. Heimlich, “he became irate, immediately filed grievances and charges of unethical medical practice against me with the AMA. the AHA, the Amercian Society of Anaesthesia, my own Washington State Medical Societies and both of the hospitals in which I practiced.”
PETER HEIMLICH- THE SON, AND GREATEST CRITIC.

Enter Peter Heimlich- Dr. Henry Heimlich’s son. He has spent just over a decade now discrediting and exposing his father, saying he has a “wide ranging, unseen 50 year history of fraud.”
Peter explains how he began to see discrepancies with his father’s claims and became concerned that people would be put at unnecessary risks of serious harm. After he took his concerns to the medical fraternity and the media, with no response, he created a website with the sole intent of exposing his father’s “dubious medical theories.”

So what are these theories that Peter Heimlich is referring to?

Dr. Heimlich’s statements that the Heimlich Manoeuvre can also treat Cystic Fibrosis and Asthma as well as assist in the first aid reaponse for drowning victims, has come under attack from experts in the field. Internal damage as well as aspiration of stomach contents are the biggest concerns.
“The Heimlich Manoeuvre is not an accepted medical practice as response for drowning victims. Unless the medical authorities- the AHA, Red Cross- were to adopt it I don’t see how anyone could advocate its use,” says Gerald Dworkin, a consultant with Lifesaving Resources Inc. in Maine. “Dr. Henry Heimlich is the only one who has come up with supporting studies.”

Dr. Heimlich has also been widely criticised by leading H.I.V. researchers for his involvement in ‘Malariotherapy’, in which he states that inducing high malarial fevers can stimulate the immune system to fight H.I.V, Lyme Disease and cancer. Heimlich commissioned experimental trials in China on H.I.V patients, infecting them with Malaria, an act which the World Health Organisation has described as an ‘atrocity.’

In 2006, the American Red Cross revised its protocols on how to treat a conscious choking victim. It replaced the HM with back blows, citing there was no evidence that the HM was effective.
Currently, the American Heart Association still recommends the use of the Heimlich Manoeuvre but have renamed it as ‘abdominal thrusts’.

Australia has never taught the Heimlich Manoeuvre and continues to teach back blows and chest thrusts for a complete obstruction.

Book in for a First Aid course today. Learn about choking and other life saving techniques- you never know when you or a loved one might need them.

Studies of complications of the Heimlich Manoeuvre:
http://www.ncbi.nlm.nih.gov/pubmed/9918460
http://www.ncbi.nlm.nih.gov/pubmed/11268942
http://journals.lww.com/jtrauma/Citation/2002/11000/Complications_of_the_Heimlich_Maneuver__Case.26.aspx
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361011/pdf/postmedj00094-0035.pdf

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