Dear Mr. Davidson,

I recently read of your interview with Dr. Henry Heimlich and am moved to write to you.

When I first learned of Dr. Heimlich’s proposal of the maneuver for relieving choking sometime around 1973 or 1974, I was a consultant to the American Heart Association’s (AHA) Emergency Cardiac Care (ECC) Committee and active in research in the area of emergency airway management. I am an Anesthesiologist and was, at the time, in practice in Everett, Washington.

Having been interested in resuscitation for many years, I was excited about Dr. Heimlich’s proposal. Creating an “artificial cough” made a lot of sense to me.

Because Dr. Heimlich used dogs for his experiments and since the dog has a much different anatomical configuration compared with the human, I proposed to the ECC my idea of a study on human volunteers and was encouraged to proceed. I think there was an overall excitement over the “Heimlich” concept.

I contacted Dr. Heimlich to review with him, the exact procedure as he conceived it. He was excited about my study and was, at first, very cooperative and encouraging. He asked that I let him know of the results of this study as soon as possible as he had a lecture to give in the near future, wanting to know of results of my study.

While designing the protocol for this study, I decided to make a comparison between applying the “thrust” to the upper abdomen (Heimlich) and applying the “thrust” to the mid chest. We measured peak pressures and volumes created by the different maneuvers in six anesthetized human volunteers.

What became evident was that greater peak pressures, flows and volumes of air moved resulted with the “Chest Thrust” than with the “Abdominal Thrust” (Heimlich). I reported this to Dr. Heimlich. He went ballistic, nasty. His personality changed completely. I was shocked and amazed. My amazement and shock was only beginning. He immediately filed unethical medical practices against me with the American Medical Association, American Society of Anesthesiologists, Washington State Medical Association, my local hospitals, the American Heart Association and there may have been others. Dr. Heimlich made my life a wreck for two years while all of the investigations and name calling continued.

No less a person than Dr. John Bonica, then chairman of the department of Anesthesiology at the University of Washington and world renowned as a sound and effective medical investigator was tapped to study this case. When he concluded he told me that, had he conceived a study on this subject he would have designed it very much the same as had I. Coincidentally however, medical ethics relating to anesthetized human volunteer studies was in the process of changing and this study would, in the future not fall into the category of proper medical ethics because of the “risk” to the human volunteers.

Because I had undertaken the study prior to this change and with no prior knowledge of the coming change, I was completely exonerated.

It was from my study and publication in the Journal of Emergency Room Physicians in September of 1976 that the terms of “Abdominal Thrust” and “Chest Thrust” were originated.

I am reluctant to speak out too vigorously on the subject of the Heimlich Maneuver because I could be too easily construed to have some personal reasons for doing so, thinking it better for others at the level of the National Academy of Sciences, the American Heart Association and the American Red Cross to work their way through the morass of “science” and “ego” and “medical politics” of the issues involved.

Thus it has been for all these years since 1976 that Dr. Heimlich has waged his campaign for the “exclusive” use of the Heimlich Maneuver as opposed to the “Chest Thrust” for the relief of acute choking.

I have a litany of reasons why I believe that the Chest Thrust is the preferred technique but will save further description for such time as you may have an interest in learning them from me with direct contact.

What I suggest to you now is that you look very carefully at both sides of this important controversy, study the players, their conduct, their background and all of the reasons why such controversy has gone on for so long.

I started out applauding Dr. Heimlich for what I still consider a landmark idea and concept. What I have learned since is that Dr. Heimlich is not what he portrays himself to be. Should anyone disagree with him, he is a nasty, vindictive and intellectually dishonest man. I am restraining myself.

I will not go into some of the other areas of Dr. Heimlich’s medical treatments here as they are in areas in which I am not authoritative.

I am willing to discuss these issues with anyone wanting to learn more with an open mind.

Yours very truly,

Charles W. Guildner MD

The mean peak airway pressure was significantly lower with abdominal thrusts compared to chest compressions…Standard chest compressions therefore have the potential of being more effective than the Heimlich manoeuvre for the management of complete airway obstruction by a foreign body in an unconscious patient.

Although chest thrusts, back slaps, and abdominal thrusts are feasible and effective for relieving severe FBAO in conscious (responsive) adults and children 1 year of age or younger, for simplicity in training we recommend that the abdominal thrust be applied in rapid sequence until the obstruction is relieved.  If abdominal thrusts are not effective, the rescuer may consider chest thrusts. It is important to note that abdominal thrusts are not recommended for infants 1 year of age or younger because thrusts may cause injuries.