Heimlich Maneuver Research Articles

Sudden Cardiac Arrest in a Seasonal Holiday Performer

HISTORY: 18 yo white male presents to the ER in cardiac arrest. He was eating when he collapsed. Heimlich maneuver was unsuccessful. EMS arrived in a few minutes and ACLS was started. Initial rythm was sinus tachycardia with change to ventricular fibrillation. He was defibrillated three times into sinus tachycardia. In the ER given amiodarone and hypothermia was induced. His girlfriend mentioned patient was complaining of palpitations and neck pain following intense physical activity during a four hour long Halloween haunted walk. Negative past medical history. Mother deceased secondary to cardiomyopathy. He is an avid snowboarder and works as snow board instructor. He denies illicit drug use. PHYSICAL EXAMINATION: Sedated on ventilation support. HR 55, BP 110/80. RRR,no murmur,S4 gallop. Lungs CTA B/L. Neuro:4mm fixed pupils, Neg Doll's eyes, neg blink reflex, no withdrawal to painfull stimuli. DIFFERENTIAL DIAGNOSIS: 1.STEMI 2.LQTS 3.Drug induced cardiac arrest 4.HCM 5.Brugada syndrome 6.CVA TEST AND RESULTS: EKG: Initial: right atrial enlargement, ST elevation and IVCD. Subsequent: sinus bradycardia, prolonged QT. Neg drug screen. NL blood glucose and LFT's. LDL 43,Cr 1.5, troponin 1.2, CK 7873,TG 252, CXR: Good ET tube placement, no pneumothorax, no fractures. Cardiac Cath: LV systolic dysfunction with normal coronary arteries. 2D ECHO: First day, EF 20 %, global hypokinesis, normal LV wall thickness. 5 days later: EF 40%, globalhypokinesis. 5 months later: EF 45% and questionable PFO. Neg CT head. Negative LQTS genetic testing FINAL WORKING DIAGNOSIS: Idiopathic sudden cardiac arrest TREATMENT AND OUTCOMES: After hypothermic protocol he was weaned off of the ventilator. Amiodarone was discontinued and an AICD was placed. Discharged on aspirine,lisinopril and carvedilol. On follow up visits, patient asking about return in physical activities, especially snowboarding. Only class 1a sports were recommended. He was last seen about one year following his cardiac arrest. He denied any new symptoms. His AICD was interrogated and found no ventricular fibrillation events. His AICD was adjusted to a higher VT zone. He was continued on beta-blocker medication to limit his heart rate. He is compliant with avoiding strenuous activities as recommended by 36th Bethesda Conference eligibility recommendations.

Heimlich′s maneuver-assisted bronchoscopic removal of airway foreign body

Aspiration of foreign bodies (FBs) by children can lead to serious illness and sometimes even death. Bronchoscopic removal of the FB is necessary to prevent from any catastrophic event. Sometimes bronchoscopic removal is not possible due to the larger size of the FB, sharp FB, or long duration FB. Tracheostomy is normally used for the removal of such FBs. The aim of this case report is to highlight the use of Heimlich maneuver for the removal of such FBs before opting invasive procedures. In the present case, a 5-year-old child was presented with history of FB aspiration 5 h back. After multiple failed bronchoscopic attempts to remove the FB it was decided to use Heimlich maneuver in the supine position. A single attempt of Heimlich maneuver expelled the FB into the oral cavity, which was removed by Magill's forceps. On repeated bronchoscope check, there was no remnant of FB. Child's further course of stay in hospital was uneventful. In conclusion, Heimlich maneuver may be useful in patient with failed bronchoscope removal of airway FBs before proceeding for tracheotomy or other invasive procedures.

Upper airway obstruction in handicapped persons

Purpose of the study: Foreign body aspiration is most common cause of upper airway obstruction in handicapped persons with neurologic disorders. Families who take care of these persons have to perform sequence of airway obstruction. This maneuver is most important and difficult in persons with high body mass, sitting on the wheelchair. Purpose of this study is modification of airway obstruction sequence dedicated to this people. The problem is how to give them abdominal thrusts.Materials and methods: 22 years old choking female on the wheelchair. Her body mass was 60 kg and it wasn’t possible to pick her up. She was at home with her mother—emergency physician. Mother performed airway obstruction sequence on the wheelchair. Slope her forward and gave her 5 effective back blocks. There was no improvement. Woman stood behind, wrapped hands around wheelchair and waist to give her abdominal thrusts. The second was successful.Results: In our opinion this technique modification is very simple. Specially relate to persons who are not independent and their body mass is high. The Heimlich maneuver is the most commonly used intervention, with high rate of patient improvement.Conclusions:1.Airway obstruction sequence in handicapped persons can be successfully done on the wheelchair.2.Unfortunately there is no information in ERC guidelines how perform this procedure in disabled people.3.The Heimlich maneuver is effective also in sitting position. Purpose of the study: Foreign body aspiration is most common cause of upper airway obstruction in handicapped persons with neurologic disorders. Families who take care of these persons have to perform sequence of airway obstruction. This maneuver is most important and difficult in persons with high body mass, sitting on the wheelchair. Purpose of this study is modification of airway obstruction sequence dedicated to this people. The problem is how to give them abdominal thrusts. Materials and methods: 22 years old choking female on the wheelchair. Her body mass was 60 kg and it wasn’t possible to pick her up. She was at home with her mother—emergency physician. Mother performed airway obstruction sequence on the wheelchair. Slope her forward and gave her 5 effective back blocks. There was no improvement. Woman stood behind, wrapped hands around wheelchair and waist to give her abdominal thrusts. The second was successful. Results: In our opinion this technique modification is very simple. Specially relate to persons who are not independent and their body mass is high. The Heimlich maneuver is the most commonly used intervention, with high rate of patient improvement. Conclusions:1.Airway obstruction sequence in handicapped persons can be successfully done on the wheelchair.2.Unfortunately there is no information in ERC guidelines how perform this procedure in disabled people.3.The Heimlich maneuver is effective also in sitting position.

The Table Maneuver: A Procedure Used with Success in Four Cases of Unconscious Choking Older Subjects

Background Confronted with an unconscious choking victim, it is recommended to call an ambulance and start mouth-to-mouth and cardiopulmonary resuscitation (CPR). We describe a procedure called the “table maneuver” that was successful in relieving foreign-body airway obstruction in 4 cases of choking in unconscious elderly patients over a 6-year period in the same long-term care facility. Methods The patients ranged in age from 70 to 89 years and were cyanosed and unconscious after choking while having a meal at a table. In a first attempt in 1 case, after failure of the Heimlich maneuver in 2 cases, and in combination with CPR in 1 person in cardiac arrest, the choking person was laid down on the table in prone position with the head facing downwards, with the arms hanging over the table, and then given sharp blows between the scapulas with the heel of the hand. Results After a few back blows in 3 cases, and in combination with CPR in 1 case, the patients forcefully spit out the foreign body (pieces of beets, Brussels sprouts, a croissant soaked in milk, or pieces of banana) without either early or late complications. Conclusion These 4 case reports show that the table maneuver is a potentially life-saving technique that could be applied to patients with severe choking caused by foreign-body airway obstruction who fail to respond to the Heimlich maneuver and other conventional treatments.

Principles of Physics in Surgery: The Laws of Mechanics and Vectors Physics for Surgeons—Part 2

In this sequel, to an earlier article, we discuss the laws of Mechanics, Thermodynamics and Vectors as they apply to soft and bony tissues. These include the Laplace's Law as applied to colonic perforation, compression therapy, parturition, variceal rupture, disc herniations etc. The Pascal's Law finds use in hernia repair and the Heimlich maneuver. Trigonometrically derived components of forces, acting after suturing, show ways to reduce cut-through; the thickness and the bite of suture determines the extent of tissue reaction. The heating effect of current explains the optimum gap between the prongs of a bipolar cautery and the use of law of transfer of heat in determining relation between healthy wound healing and ambient temperature.

Cardiac arrest due to food asphyxiation in adults: Resuscitation profiles and outcomes

Aim Food asphyxiation is uncommon but unignorable cause of sudden death in the elderly. Several autopsy studies, which identified those at particular risk, have been conducted on the subject. Resuscitation profiles and outcomes of food asphyxiation victims presenting with out-of-hospital cardiac arrest (OHCA) to the emergency department, however, have rarely been reported. Methods Data on adults (≥20 years) presenting with OHCA after witnessed food asphyxiation were retrieved from an institutional database. Clinical variables were evaluated to identify their demographic characteristics. Their outcomes, represented by return of spontaneous circulation (ROSC) and survival rate, were also investigated. Results Sixty-nine food asphyxiation victims presenting with OHCA were identified during the 4-year period. Food asphyxiation occurred most frequently in the age group of 71–80 years, followed by that of 81–90 years. The majority of victims had medical conditions that adversely affected mastication/swallowing, such as dementia. Bystander cardiopulmonary resuscitation (CPR) was performed only in 26%, although bystanders often attempted to clear the airway without performing CPR. Despite the high ROSC rate of 78%, only 7% survived to discharge. Asphyxiation–ROSC interval might play a crucial role in determining the outcomes: the interval was ≤10 min in all survivors, while it was longer than 10 min in all non-survivors. Conclusion Because of their advanced age and debilitating general condition, it may be difficult to substantially improve the outcomes of food asphyxiation victims. Effort should be directed to prevent food asphyxiation, and public education to perform standard CPR for food asphyxiation victims including the Heimlich manoeuvre is warranted.

The Heimlich Maneuver: Breaking Down the Complications

The very young and the very old are vulnerable to choking, and there are over 4000 choking-related deaths annually in the United States. Complications from the Heimlich maneuver (HM), as reported in infrequent case reports, predominantly relate to the elderly. It is doubtful that the denominator, numerator, appropriateness, expertise, and problems of maneuvers applied to choking victims will ever be known. This case report and literature review suggests that the treatment for acute elderly choking victims should be applied carefully and that esophageal food impaction, which should be rapidly distinguishable from choking, can have serious complications with application of the HM.

The evolution of evidence hierarchies: what can Bradford Hill's ‘guidelines for causation’ contribute?

High quality randomized controlled trials (RCTs) (concealed allocation, relevant groups blinded and sufficiently powered, etc.) will usually provide sufficient evidence to establish that a particular treatment caused an outcome. Yet sufficiently well‐conducted RCTs are rare.1 Trials can be under‐powered,2 or unsuccessfully blinded,3,4 and often suffer from many undetected biases. The results of most RCTs are therefore often insufficient to establish causation. At the same time, RCTs are often not required to establish causation.5 Treatments including the Heimlich manoeuvre, cardiac defibrillation and parachutes to prevent death6 have never been tested in RCTs, yet their effectiveness is surely strongly supported by evidence. Evidence‐grading systems that place randomized trials at the top of a hierarchy7–13 will deliver misleading conclusions in cases where RCTs are insufficient or unnecessary. According to these hierarchies, trails of homeopathy – often generating positive results and generally of higher quality than RCTs of conventional treatments14 – will be considered to provide strong evidence, whereas the evidence base for the Heimlich manoeuvre to unblock airways and parachutes to prevent death will be judged as less strongly supported by evidence. Sir Austin Bradford Hill, in a widely‐cited ‘pre‐EBM’ system for appraising evidence, suggested that several relevant factors must be considered before concluding causation. We investigated and revised the Bradford Hill ‘guidelines for causation’, in order to refine our intuitions about whether to believe that intervention is effective. Our intention is not to debunk previous attempts to grade evidence, but rather to contribute to their natural evolution and development.

Complications as a Result of the Heimlich Maneuver

The Heimlich maneuver is a well-described emergency procedure for management of foreign body airway obstructions. Although rare, complications of the Heimlich maneuver do exist. The purpose of this report is to review the known complications of this procedure. All reported complications published in English on Medline and PubMed were reviewed. Additionally, we present a rare case of acute pancreatitis with associated pseudocyst formation after the administration of the Heimlich maneuver on a healthy 3-year-old boy. Although life saving, the Heimlich maneuver may be associated with significant complications; thus, symptomatic patients after this maneuver should be thoroughly evaluated with appropriate laboratory and radiographic studies.

Foreign body airway obstruction

According to the National Safety Council’s statistics, foreign-body airway obstruction (FBAO) is the fourth leading cause of unintentional death, resulting in 5,051 documented deaths in 2015. In children under the age of 16, foreign-body airway obstruction is one of the leading causes of accidental deaths. Due to the prevalence and rapidity of unconsciousness and death associated with choking, all persons, including those outside of the health field, should have a basic understanding of how to care for a choking victim. Simple maneuvers taught to lay-people, such as the Heimlich maneuver, have been proven to save lives. Besides complete foreign body airway obstruction that is immediately life-threatening, partial airway obstructions can impede gas exchange and lead to dyspnea, pneumonia, and abscess formation.

Traumatic dissection and rupture of the abdominal aorta as a complication of the Heimlich maneuver

Although the Heimlich maneuver is considered the best intervention for relieving acute upper airway obstruction, several complications have been reported in the literature. These complications can occur as a result of an increase in abdominal pressure leading to a variety of well-documented visceral injuries, including the great vessels. Acute abdominal aortic thrombosis after the Heimlich maneuver is a rare but recognized event; however, to date no case of traumatic dissection and rupture of the abdominal aorta has been described. We report the first known case, to our knowledge, of a traumatic dissection and rupture of the abdominal aorta after a forcefully applied Heimlich maneuver.

ACUTE ABDOMINAL AORTIC THROMBOSIS AS A COMPLICATION OF THE HEIMLICH MANEUVER

ACUTE ABDOMINAL AORTIC THROMBOSIS AS A COMPLICATION OF THE HEIMLICH MANEUVER

Hepatic Rupture After Heimlich Maneuver

Choking is an emergency problem. Henry Heimlich first described his lifesaving maneuver of abdominal infradiaphragmatic pressure to dislodge aspirated food from upper airways in 1974.1Ayerdi J. Gupta S.K. Sampson L.N. et al.Acute abdominal aortic thrombosis following the Heimlich maneuver.Cardiovascular Surgery. 2002; 10: 154-156Crossref PubMed Scopus (12) Google Scholar The Heimlich maneuver is an efficient resuscitative procedure in the management of cases with airway obstruction secondary to foreign body. The most common complication is rib fracture2Fearing N.M. Harrison P.B. Complications of the Heimlich maneuver: case report and literature review.J Trauma. 2002; 53: 978-979Crossref PubMed Scopus (25) Google Scholar; however, Heimlich maneuver was associated with potentially infrequent and severe complications that may have serious consequences if not recognized and treated correctly. All patients subject to this maneuver should be examined by a physician. Reports of complications have been few. A list of complications found during a review of the literature are in the Table.TableReported cases of complication after Heimlich maneuver.ComplicationNumber of CasesGastric rupture11Pneumomediastinum3Esophageal rupture2Jejunum rupture1Mesenteric laceration1Diaphragmatic hernia1Internal carotid artery dissection3Rakotoharinandrasana H. Petit E. Dumas P. et al.Internal carotid artery dissection after Heimlich Maneuver.Ann Fr Anesth Reanim. 2003; 22: 43-45Crossref PubMed Scopus (12) Google Scholar1Acute thrombosis of abdominal aortic aneurysm3Acute abdominal nonaneurysmal aortic thrombosis1Rupture aortic valve cusp1Acute aortic regurgitation1 Open table in a new tab We found a case of dislodgement of thrombus from an atherosclerotic nonaneurysmal aorta which resulted in thromboembolic occlusion of both lower extremities.4Mack L. Forbes T.L. Harris K.A. Acute aortic thrombosis following incorrect application of the Heimlich maneuver.Ann Vasc Surgery. 2002; 16: 130-133Abstract Full Text PDF PubMed Scopus (19) Google Scholar We found a case of witnessed laryngeal obstruction by a foreign body in which repeated Heimlich maneuvers dislodged the foreign body into the trachea and may have contributed to the rapid development of surgical emphysema, pneumomediastinum and pneumopericardium.5Nowitz A. Lewer B.M. Galletly D.C. An interesting complication of the Heimlich manoeuvre.Resucitation. 1998; 39: 129-131Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar We found other cases of herniation of an emphysematous bulla into the mediastinum as a result of increased intrathoracic pressure from foreign body aspiration and performance of the Heimlich maneuver. We submit the first report of hepatic rupture following the Heimlich maneuver. An 88-year-old man presented to the emergency department 2 hours after airway obstruction with a bolus of meat and subsequent Heimlich maneuver. After the procedure the patient complained of abdominal pain. Physical examination demonstrated that his abdomen was significantly distended and diffusely tender. A computed tomography of the abdomen was obtained and it revealed a contusion and laceration in the left hepatic lobe with hemoperitoneum (Figure). The patient received medical therapy with observation and he was discharged 14 days later. This case, as well as others related in the literature, demonstrate that all patients who received Heimlich maneuver should be examinated by a physician to recognize this rare but potentially serious complication and decrease morbidity.

Adult Foreign Body Airway Obstruction in the Prehospital Setting

Background. Although the treatment of foreign body airway obstruction in adults has been well studied, few data exist on the characterization of prehospital experiences. Objectives. To describe the frequency, etiologies, andtreatments of foreign body airway obstruction in adults in the prehospital setting andto discuss the relative efficacies of treatments andpresenting factors that predict overall patient outcome. Methods. A San Diego County prehospital database was retrospectively reviewed for all adult patients over a 17-month period with data extracted on demographic characteristics, incident outcome, patient disposition, item involved in obstruction, location of episode, initial vital signs, initial level of consciousness, pertinent medical history, treatments initiated by bystanders andparamedics, andresponse to those treatments. Results. During the study period, there were 513 cases of foreign body airway obstruction in adults. Of these, 17 (3.3%) died. The mean age was 65.0 years, with increasing age correlating with worse outcome. The item causing obstruction varied widely, with medications andmeat being the most common items. The Heimlich maneuver was the most commonly used intervention, with an 86.5% rate of patient improvement. Magill forceps proved useful for three cases refractory to the Heimlich maneuver. Presenting vital sign aberrations, particularly with respiratory rate, correlated with poorer patient outcome. Conclusions. Foreign body airway obstruction represents a true emergency in adults, with a 3.3% mortality rate in the current study. The Heimlich maneuver was used frequently andwith good success. Key words: paramedic; choking; adult; foreign body.

Pancreatic Transection as a Complication of the Heimlich Maneuver: Case Report and Literature Review

From the Department of Pediatrics (S.F.); Division of Pediatric Surgery, Department of Surgery (W.P.); Division of Trauma, Burns and Surgical Critical Care, Department of Surgery (M.L.G.), University of Rochester School of Medicine, Rochester, New York. Submitted for publication August 12, 2004. Accepted for publication February 2, 2005. Address for reprints: Mark Gestring, MD, FACS, Division of Trauma, Burns and Surgical Critical Care, Strong Regional Trauma Center, University of Rochester School of Medicine, 601 Elmwood Avenue, Box SURG, Rochester, New York 14642-8410; email: [email protected].

Internet-based animation for instruction in cardiopulmonary resuscitation

We have trialled the use of computer animation for teaching basic life support (BLS) to the general public. Two resuscitation scenarios were selected. The first was adult CPR and the second was the management of foreign body airway obstruction using the Heimlich manoeuvre. A manikin was used as the patient. The exact motions performed by the participants during a simulated resuscitation were digitized by using a motion capture technique. Twenty students who had not previously received BLS education were given one hour of traditional instructor-based skill training, and another group of 20 was given one hour of skill practice via the Internet-based animation, which was displayed on a PC monitor. A skill meter on the manikin was used to evaluate the accuracy of CPR skills. Two items, ventilation and compression skills, were assessed and showed no significant differences between the two groups. The results suggest that by using computer animation of BLS through a PDA or a mobile phone, members of the public could maintain their CPR skills.

Deaths due to choking in Prader–Willi syndrome

Prader-Willi syndrome (PWS) is the most common known syndromic cause of life-threatening obesity, yet few studies have examined the causes of death in PWS. The objective of this study was to examine the contribution of choking leading to mortality in PWS. In 1999, a brief survey was made available from the Prader-Willi Syndrome Association (USA) bereavement program, which documented demographic data and causes of death. Families were subsequently offered the opportunity to fill out a detailed questionnaire and additional forms to release medical records. Demographic information was available on 178 deceased individuals with PWS, and cause of death available on 152 individuals. Fifty-four families completed questionnaires. Of the deceased individuals with completed questionnaires, 34% reported a history of choking. Choking was listed by familial report as the cause of death in 12 (7.9%) of 152 subjects with an average age of 24 years (range 3-52 years; median 22.5 years) at death from choking. Only two of these individuals were less than 8 years of age. The data suggest that risks associated with choking are different in the PWS population compared with others. Potential causes of increased choking in PWS include poor oral/motor coordination, poor gag reflex, hypotonia, hyperphagia, decreased mastication, and voracious feeding habits. We recommend implementation of preventive measures and education for families and group home care providers for all individuals with PWS including the Heimlich maneuver, supervised meals, better food preparation, and diet modification to avoid high-risk choking items.

Lower respiratory tract foreign bodies: A retrospective review of morbidity, mortality and first aid management

The authors describe 28 pediatric cases of foreign body inhalation requiring treatment in intensive care units between 1987 and 1999. The purpose of this study was: (1) to analyze the circumstances, diagnostic difficulties and initial treatment of serious foreign bodies and (2) to compare our series with other literature descriptions and define principles for optimal prevention and initial treatment. Twenty-one children presented a penetration syndrome, which was responsible in 13 cases for asphyxia with cardiorespiratory arrest. All these children died, regardless of the initial treatment. Seven children were hospitalized for apparent asthmatic symptoms that did not respond to traditional treatment. The inefficiency of external extraction methods like the Heimlich maneuver and the mean delay between clinical signs and initial treatment lead us to propose a new strategy for the emergency treatment of foreign bodies with asphyxia. We recommend that emergency teams promote the use of a laryngoscope and Magill forceps. Flexible endoscopy is still recommended as the appropriate diagnostic tool to eliminate doubt in the case of a first severe asthma attack.

What Is in a Name?

The creation of an institutional identity is an essential process in the development of a successful product, business, or organization. Efforts to link a product or service to a specific brand name identity can be critical in obtaining consumer acceptance, and is often easier said than done. When successful, a brand name becomes synonymous with the organization, process, or product formulating a unique public awareness. Classic examples include Xerox, Heimlich maneuver, and the AMA. Although not specifically descriptive to the process or product, the names call to mind clear images and meaning. As an organization, the American Academy of Pain Medicine (AAPM) has struggled to create a unique identity for pain medicine. The AAPM was originally founded as the American Academy of Algology. The origins of the name derive from algos, the Greek word for pain. Derivations of this word include algesia, a commonly used …

The Perils of Vinegar and the Heimlich Maneuver

The Perils of Vinegar and the Heimlich Maneuver