Abdominal thrusts

Abdominal thrusts

Performing the Heimlich maneuver

Abdominal thrusts (also called the Heimlich maneuver or Heimlich manoeuvre, German pronunciation: [haimlɪç -]) is a first aid procedure used to treat upper airway obstructions (or choking) by foreign objects. The term Heimlich maneuver is named after Dr. Henry Heimlich, who first described it in 1974.

Performing abdominal thrusts involves a rescuer standing behind a patient and using his or her hands to exert pressure on the bottom of the diaphragm. This compresses the lungs and exerts pressure on any object lodged in the trachea, hopefully expelling it.

Most modern protocols, including those of the American Heart Association, American Red Cross and the European Resuscitation Council, recommend several stages for airway obstructions, designed to apply increasingly more pressure. Most protocols recommend encouraging the victim to cough, followed by hard back slaps, and finally abdominal thrusts or chest thrusts as a last resort. Some guidelines also recommend alternating between abdominal thrusts and back slaps.[1][2]

History

Henry Heimlich, noted for promulgating abdominal thrusts, claimed that back slaps were proven to cause death by lodging foreign objects into the windpipe.[3] The 1982 Yale study by Day, DuBois, and Crelin that persuaded the American Heart Association to stop recommending back blows for dealing with choking was partially funded by Heimlich's own foundation.[4] According to Roger White MD of the Mayo Clinic and American Heart Association (AHA), "There was never any science here. Heimlich overpowered science all along the way with his slick tactics and intimidation, and everyone, including us at the AHA, caved in."[5]

From 1985 to 2005, abdominal thrusts were the only recommended treatment for choking in the published guidelines of the American Heart Association and the American Red Cross. In 2006, both organizations drastically changed course and "downgraded" the use of the technique. For conscious victims, the new guidelines recommend first applying back slaps; if this method failed to remove the airway obstruction, rescuers were to then apply abdominal thrusts. For unconscious victims, the new guidelines recommend chest thrusts.

The European Resuscitation Council and the Mayo Clinic recommend alternating between five back slaps and five abdominal thrusts in cases of severe airway obstructions.[1][2]

In some areas, such as Australia, authorities believe that there is not enough scientific evidence to support the use of abdominal thrusts and their use is not recommended in first aid. Instead, chest thrusts are recommended.[6]

Henry Heimlich also promoted abdominal thrusts as a treatment for drowning[7] and asthma[8] attacks. The Red Cross now contests his claims that the maneuver could help drowning victims or someone suffering an asthma attack. The Heimlich Institute has stopped advocating on their website for the Heimlich maneuver to be used as a first aid measure for drowning victims. His son, Peter M. Heimlich, alleges that in August 1974 his father published the first of a series of fraudulent case reports in order to promote the use of abdominal thrusts for near-drowning rescue.[9][10] The 2005 drowning rescue guidelines of the American Heart Association[11] did not include citations of Heimlich's work, and warned against the use of the Heimlich maneuver for drowning rescue as unproven and dangerous, due to its risk of vomiting leading to aspiration.[11]

In May 2016 Henry Heimlich used the maneuver for the second time (the first was in around the year 2000), saving the life of a fellow resident at his retirement home in Cincinnati.[12] Heimlich died in hospital after a heart attack on December 17, 2016.[13]

Universal sign of choking

A choking victim is usually unable to speak, and may not be able to make much sound at all. A universal sign of choking has been designated as a silent indication from a person who is unable to breathe, and consists of placing both hands on one's own throat while trying to attract the attention of others who might assist.[14]

Technique

Performing abdominal thrusts involves a rescuer standing behind an upright patient and using his or her hands to exert pressure on the bottom of the diaphragm. This compresses the lungs and exerts pressure on any object lodged in the trachea, hopefully expelling it. This amounts to an artificially induced cough. For example, WebMD recommends the rescuer placing his or her fist just above the person's bellybutton and grasping it with the other hand. To assist a larger person, more force may be needed.[15] The Mayo Clinic recommends the same placement of fist and hand and upward thrusts as if you are trying to lift the person.[2]

If the victim is not upright, the US National Institutes of Health (NIH) recommends positioning the person on his or her back, then straddling the torso and using chest thrusts.[16]

It is possible for a still-conscious choking victim to perform the procedure on themself, without assistance.[17] The NIH recommends other procedures for children and for infants under a year old.[16]

Due to the forceful nature of the procedure, even when done correctly, abdominal thrusts can injure the person on whom it is performed. Bruising to the abdomen is highly likely and more serious injuries can occur, including fracture of the xiphoid process or ribs.[18]

Researchers at Royal Brompton Hospital, have demonstrated that similar intrathoracic pressures (50-60 cmH2O) are produced by a first aider performing abdominal thrusts inwards as are produced when the force is directed inwards and upwards.[19][20] They argue that this may be easier to perform with less concern about injury to ribcage or upper abdominal organs. Self-administered abdominal thrusts by study participants produced similar pressures to those generated by first aiders. The highest pressures were produced by participants performing an abdominal thrust onto the back of a chair (115 cmH2O).

See also

References

  1. 1 2 Nolan, JP; Soar, J; Zideman, DA; Biarent, D; Bossaert, LL; Deakin, C; Koster, RW; Wyllie, J; Böttiger, B; ERC Guidelines Writing Group. "European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary". Resuscitation. 81 (10): 1226. PMID 20956052. doi:10.1016/j.resuscitation.2010.08.021.
  2. 1 2 3 Foreign object inhaled: First aid, Mayo Clinic staff, Nov. 1, 2011.
  3. ↑ "Heimlich, on the maneuver". New York Times. 2009-02-06. Retrieved 2009-02-07.
  4. ↑ "Lifejackets on Ice (August 2005)" (PDF). University of Pittsburgh Medical School. Retrieved 2009-05-24.
  5. ↑ Pamela Mills-Senn. "A New Maneuver (August 2005)". Cincinnati Magazine. Retrieved 2013-12-22.
  6. ↑ "Australian(and New Zealand) Resuscitation Council Guideline 4 AIRWAY". Australian Resuscitation Council (2010). Archived from the original on 2014-02-14. Retrieved 2014-02-09.
  7. ↑ "Heimlich Institute on rescuing drowning victims". Retrieved 2007-06-05.
  8. ↑ "Heimlich Institute on rescuing asthma victims". Retrieved 2007-06-05.
  9. ↑ Heimlich, Peter M. "'Outmaneuvered - How We Busted the Heimlich Medical Frauds'". Retrieved 2007-06-22.
  10. ↑ Heimlich's son cites Dallas case in dispute. Wilkes-Barre News, August 22, 2007
  11. 1 2 "Part 10.3: Drowning". Circulation. American Heart Association. 112 (24): 133–135. 2005-11-25. doi:10.1161/CIRCULATIONAHA.105.166565. Retrieved 2008-04-04.
  12. ↑ Walters, Joanna (27 May 2016). "Dr Henry Heimlich uses Heimlich manoeuvre to save a life at 96".
  13. ↑ Croft, Jay. "Heimlich maneuver inventor Henry Heimlich dies at 96".
  14. ↑ "Choking first aid - adult or child over 1 year - series". MedlinePlus. National Institutes of Health. Retrieved 2016-03-11.
  15. ↑ Heimlich Maneuver for Adults and Children Older Than 1 Year - Topic Overview, WebMD, April 28, 2010.
  16. 1 2 "Abdominal thrusts". MedlinePlus. National Institutes of Health. Retrieved 2016-03-11.
  17. ↑ "Heimlich maneuver on self". MedlinePlus. National Institutes of Health. Retrieved 2016-03-11.
  18. ↑ Broomfield, James (2007-01-01). "Heimlich maneuver on self". Discovery Channel. Retrieved 2007-06-15.
  19. ↑ Pavitt, Matthew J.; Swanton, Laura L.; Hind, Matthew; Apps, Michael; Polkey, Michael I.; Green, Malcolm; Hopkinson, Nicholas S. (2017-04-05). "Choking on a foreign body: a physiological study of the effectiveness of abdominal thrust manoeuvres to increase thoracic pressure". Thorax: thoraxjnl–2016–209540. ISSN 0040-6376. PMID 28404809. doi:10.1136/thoraxjnl-2016-209540.
  20. ↑ "How to perform the Heimlich manoeuvre on yourself (and yes, it's just as effective)". The Telegraph. Retrieved 2017-04-13.
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