Saturday, December 08, 2007

Henry Heimlich’s Manuever: World Leaves Cincinnati Doctor Behind

Posted by The Dean of Cincinnati

Cincinnati native Henry Heimlich is a world-famous, household name.  But the maneuver that has brought him fame has become a left-behind.

Did you know, for example, that the American Red Cross has changed their guidelines for first response to choking?  Instead of the Maneuver, you should use a combo called the five-and-five.  That’s five backslaps followed by five Maneuvers (more properly known as abdominal thrusts).

And even the American Heart Association – whose guidelines are the model for emergency response professionals – has recently issued a press statement which suggests the Maneuver is almost out entirely for choking. What might be the possible replacement?  Chest Thrusts.

We recently talked to Dr. Guildner, inventor of chest thrusts, about these new developments.

“[The chest thrust] is near and dear to my heart as I am the one who first described the Chest Thrust and first gave it it’s name,” said Guildner.  “It has been a long time coming.”

“I thought that someday the logic and common sense of the Chest Thrust over the Abdominal Thrust finally would be recognized,” continued Guildner. “The studies indicate the Chest location of the Thrust to be more effective than the Abdominal approach.”

A few months ago, The American Heart Association and the American Red Cross issued an underreported joint statement:  “The American Heart Association recommends the use of chest thrusts if the initial use of abdominal thrusts does not successfully dislodge the foreign body.  (Chest thrusts are similar to abdominal thrusts but performed higher on the chest; the American Heart Association also recommends their use for pregnant women or people who are obese.)”

“For many years, no new compelling scientific evidence has suggested that any one technique as first line treatment is superior to another,” the statement continues. “In fact, the current international standard, developed by the International Liaison Committee on Resuscitation (ILCOR), states that a combination of more than one technique—abdominal thrusts, back slaps and chest thrusts—is generally needed.”

Between the lines of the joint statement is an acknowledgment that Heimlich is on his way down that road to irrelevance and obscurity.  No new studies indicate that one technique is superior to another.

Yet across the ocean, the Australian Resuscitation Council says that back blows, chest thrusts, and abdominal thrusts can all clear the airway, but that abdominal thrusts have been known to cause injury.  Therefore, they do not recommend their use.

We’ve all heard that Cincinnati is behind the times, and it looks like the same might be true of our City’s most famous Maneuver.

Since chest thrusts are already a part of CPR, moving to standardize chest thrusts makes sense—as that would simplify an overall strategy for saving lives in emergency situations.

Time will tell, but it looks like the Heimlich Maneuver is headed toward a future of being nothing but a footnote.

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Pelvic Thrust says:
09 Dec 2007  at  03:23 am | #

So it’s quack versus quack? Does Guildner have the chest thrust patented?

...That’s five backslaps followed by five Maneuvers…
...the Maneuver is almost out entirely for choking…

If you were honest, you would say the ARC and AHA still endorse the Heimlich Maneuver.

says:
09 Dec 2007  at  06:13 am | #

That’s just your political spin.  What’s honest is that research shows it’s not the best method, overseas the HM is already out of use, and in our country modifications are being made which indicate it will fall out of use as we follow the lead of already established, global, research-based protocols.

Joy Velveeta says:
09 Dec 2007  at  10:22 am | #

Does Guildner have the chest thrust patented?

You can’t patent a non-product such as the chest thrust, the abdominal thrust, or backblows. However, “Guildner Maneuver” perhaps could be trademarked, just as Dr. Heimlich filed to trademark “Heimlich Maneuver” in August 1976, per this page from the US Patent & Trademark Office. (The information from the page is copied below.)

Along those lines, the website of the Heimlich Institute at Deaconess attaches the trademark symbol @ to the phrase “Heimlich Maneuver.” Note that the word “maneuver” is also capitalized.

Now the Red Cross and Heart Association appear to be phasing out the use of Heimlich Maneuver@ (all rights reserved), although it continues to be used in the vernacular.

Dean, for accuracy in future articles, you may wish to attach the trademark symbol to Heimlich Maneuver@. 

---

Word Mark HEIMLICH MANEUVER
Goods and Services IC 041. US 107. G & S: EDUCATIONAL SERVICES-NAMELY, THE DISSEMINATION OF INSTRUCTIONAL INFORMATION RELATING TO AN ANTI-CHOKING FIRSTAID TECHNIQUE. FIRST USE: 19750815. FIRST USE IN COMMERCE: 19750815
Mark Drawing Code (1) TYPED DRAWING
Serial Number 73095410
Filing Date August 2, 1976
Current Filing Basis 1A
Original Filing Basis 1A
Change In Registration CHANGE IN REGISTRATION HAS OCCURRED
Registration Number 1082922
Registration Date January 17, 1978
Owner (REGISTRANT) EDUMED, INC. CORPORATION OHIO P.O. BOX 52 CINCINNATI OHIO 45201

(LAST LISTED OWNER) HEIMLICH INSTITUTE, INC., THE CORPORATION ASSIGNEE OF OHIO 2368 VICTORY PARKWAY CINCINNATI OHIO 45206
Assignment Recorded ASSIGNMENT RECORDED
Attorney of Record LOUIS K EBLING
Type of Mark SERVICE MARK
Register PRINCIPAL
Affidavit Text SECT 15. SECT 8 (6-YR).
Renewal 1ST RENEWAL 19980916
Other Data “HEIMLICH” IS THE NAME OF A LIVING INDIVIDUAL WHOSE CONSENT IS OF RECORD.
Live/Dead Indicator LIVE

anon says:
09 Dec 2007  at  04:42 pm | #

Seattle public radio just broadcast a strong story about the Guildner/Heimlich battle. Audio and text are online:

Heimlich Maneuver by Patricia Murphy, KUOW, December 3, 2007: http://www.kuow.org/defaultProgram.asp?ID=13931

coughitup says:
09 Dec 2007  at  11:03 pm | #

Jason, with all due respect please try to talk to professionals before giving out medical advice. Having just re-certified last week in CPR airway/intubation, this is what’s taught per American Heart Assoc. guidelines in Hamilton County:

1. For a conscious, choking adult, give abdominal thrusts (yes, the H-maneuver)until the object is dislodged, or the patient loses consciousness. Should the latter take place, lower the patient to the floor, activate 911, open their airway and begin CPR, which now consists of 30 chest compressions at a ratio of least 100 compressions/min to 2 breaths, visually checking the mouth following compressions for the foreign object. This is a fairly recent change; previous foreign body removal attempts had us continuing the H-maneuver on the supine patient until the object was expelled, and/or transport arrived. As someone above mentioned, chest thrusts have always been the preferred method for pregnant women and some morbidly obese patients. 

This technique holds for adults and children down to 1 year in age; 0 to 1-year-olds ONLY receive the cycle of five back blows to five chest thrusts using two fingers only, holding the infant on one forearm (facedown with the head cradled in the hand for the back blows) then transferring it to the other arm, face-up, for the chest thrusts, attempting breaths after each cycle. There are lots of other scenarios for one-and-two rescuer CPR that also involve intubation and defibbrilation in the field; the main thing is to get qualified help on scene as quickly as possible to take over care and get the patient to a hospital.

The same basic CPR technique is also utilized for a drowning victim, not the H-maneuver. The Heimlich technique may well be phased out in the future but at least for now is very much part of the ALS and BLS protocol in this area.

Freedom Fighters says:
10 Dec 2007  at  04:43 am | #

.

When we are gasping for our last breath, we hope we receive a chest thrust and pelvic thrust simultaneously.

Repeat.

Repeat, repeat.

Repeat, repeat, repeat.

.

Factotum says:
10 Dec 2007  at  08:17 am | #

FOR IMMEDIATE RELEASE, April 11, 2007
CONTACT: Tagni McRae, Pamela King
American Heart Association, American Red Cross
214-706-1383, 202-303-4436



American Heart Association and American Red Cross Statement: Recommendation for treating choking in conscious adult victims

The American Heart Association and American Red Cross have become aware of recent reports of changes in how to best relieve choking in conscious adults. These reports emphasize the new American Red Cross recommendation to use back slaps (back blows) as the first line of treatment and the American Heart Association’s recommendation to use abdominal thrusts as the first line treatment.

Although correct in pointing out the differences in the recommended first line treatment, some of the media reports have not acknowledged the fact that the American Red Cross continues to recommend the use of abdominal thrusts if the initial use of back slaps does not successfully dislodge the foreign body that’s blocking the conscious adult’s airway.

The American Heart Association recommends the use of chest thrusts if the initial use of abdominal thrusts does not successfully dislodge the foreign body. (Chest thrusts are similar to abdominal thrusts but performed higher on the chest; the American Heart Association also recommends their use for pregnant women or people who are obese.)

For many years, no new compelling scientific evidence has suggested that any one technique as first line treatment is superior to another. In fact, the current international standard, developed by the International Liaison Committee on Resuscitation (ILCOR), states that a combination of more than one technique—abdominal thrusts, back slaps and chest thrusts—is generally needed.

The American Heart Association and American Red Cross are the two leading organizations training lay rescuers to do CPR, perform first aid and use automated external defibrillators (AEDs). Both are committed to training more people to respond to cardiovascular emergencies and to save more lives.

###

Going Down says:
10 Dec 2007  at  06:22 pm | #

Face it- The H.maneuver went down in April and this city is the last to know about it- other than the Beacon Stories. And if people are still being trained using it, then you have been trained according to old protocols. Abdominal thrust are not the H.maneuver! They are higher and do not cause the damage to the liver that the maneuver can cause.

anon says:
11 Dec 2007  at  08:55 am | #

Going Down: Abdominal thrust are not the H.maneuver! They are higher and do not cause the damage to the liver that the maneuver can cause.

Abdominal thrusts are the same as the Heimlich. I think you meant chest thrusts.

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