by Robert S. Baratz, MD, PhD, DDS

For years Henry Heimlich and his associates have promoted abdominal thrusts, the so-called Heimlich maneuver, as a first measure in the treatment of near-drowning.  Despite a lack of data, studies, and physiological or medical sense ,abdominal thrusts have been advocated by Dr. Henry Heimlich, regularly, in multiple venues.  Heimlich’s advocacy is based on his opinion, using arguments, described by reporter Pamela Mills-Senn, who wrote an extensive review on the matter, and quoted recently, as “circular, using his own pronouncements to validate his theories.”

Even this month, Heimlich’s spokesperson, Robert Kraft was using similar rhetoric when quoted in Cincinnati Magazine in an extensive article on Heimlich.  Heimlich refused to be interviewed.

Heimlich’s advocacy of abdominal thrusts as a first measure for drowning seems to emanate from a chain of only eight highly questionable cases, which lack complete and accurate case reports.  He offers no scientific studies to support his contentions.  The National Council Against Health Fraud asked Dr. Heimlich for details on his cases on multiple occasions over the past year and nothing has been produced.  Even the so-called Lima Case, in which Dr. Edward Patrick, Heimlich’s longtime collaborator, and whose credentials have been called into question in several press articles, claimed to be have supporting evidence of the effectiveness of “the Heimlich maneuver”, lacks such evidence.  Reading Patrick’s alleged account of the case from his own alleged records shows that his “proof” that water gushed from the lungs from abdominal thrusts was based on his observations before the endotrachial tube was placed.  From the record presented no reasonable physician or scientist could conclude that the alleged facts support the notion that the lungs were “full of water”.  Patrick’s case records are consistent with expulsion of abdominal contents, as one would expect.  The outcome of the Lima case was horrible. The toddler developed severe brain damage, and did not survive.  Patrick’s own description of his deviation from accepted measures of resuscitation could be viewed as malpractice by some.

And this was supposedly the first and “best described” case of any of the eight alleged cases of drowning that have been put forward as “proving” Heimlich’s pronouncements.  Robert Kraft, Heimlich’s spokesperson, who could not find time to answer the National Council Against Health Fraud’s questions about Dr. Heimlich and Kraft’s own role in the Heimlich matter, apparently found time to speak to Cincinnati Magazine.  Regarding drowning, Kraft summarized Heimlich’s claims regarding drowning as not having been “repudiated”.  The American Heart Association apparently disagrees.

The burden in scientific medicine is on the advocates to come up with data, not on others to disprove their speculations and pronouncements.  Dr. Heimlich’ s approach, as was detailed in the December Cincinnati Magazine article, The Heimlich Maneuvers, may be interpreted as “try your ideas out on patients before doing preliminary scientific investigations”.  This was corroborated by one of his longtime associates, Gerson Carr.  Safeguards for the welfare of human subjects, such as valid human experimentation review committees, seem not to be part of the Heimlich method.  His published, unpublished, and continuing pursuit of malaria injections, or lack of treatment of malaria, as a treatment for HIV infection are another case in point.  Here, pronouncement is the rule as well.  A wealth of objective scientific data show Heimlich’s speculations to be clinically invalid, and methodologically unsound. His work in this area, is, in the opinion of many, unethical and immoral.

Periodically the American Heart Association (AHA) reviews its guidelines and recommendations for resuscitation.  The process of these reviews is long, extensive, world-wide, and scientific.  The AHA committees that are charged with assessing each type of resuscitation e.g. sudden cardiac arrest, traumatic cardiac arrest, lightning strikes, drowning, choking, etc., and are required to review and analyze critically all relevant literature, and grade the quality of data available for assessment of effectiveness.  Years of careful consideration go into the guidelines, since their implementation will literally affect the lives of most people.

Previous guidelines have not promoted abdominal thrusts for drowning, but had allowed them if it was suspected that a foreign body was aspirated as part of the drowning.  Moreover, abdominal thrusts were not encouraged or promoted as first treatment for drowning in the CPR guidelines.  Now the AHA actively discourages abdominal thrusting for drowning/near-drowning resuscitation.  I quote the AHA which now states, based on thorough review:

“Attempts to remove water from the breathing passages by any means other than suction (e.g. abdominal thrusts or the Heimlich maneuver) are unnecessary and potentially dangerous.  The routine use of abdominal thrusts or the Heimlich maneuver for drowning victims is not recommended.”

“There is no evidence that water acts as an obstructive foreign body.  Maneuvers to relieve FBAO [Foreign Body Airway Obstructions] are not recommended for drowning victims because such maneuvers are not necessary and they can cause injury, vomiting and aspiration and delay CPR.”

The AHA Guidelines are based on a series of referenced articles and critical review of all evidence available.  In short Henry Heimlich’s beliefs and recommendations are discarded and actively discouraged.

Heimlich’s own son, Peter Heimlich, together with his wife Karen, have been investigating Henry Heimlich’s methods and science for the past three years.  Their thorough, relentless and well-documented work pointed to the highly questionable case reports on drowning, and critically called for an end to use of the “Heimlich maneuver” in drowning.  They were regularly attacked for their motives, and their methods.  Now the jury is in. The AHA agrees with what they have been saying.  Abdominal thrusts are ineffective, unnecessary and dangerous in drowning. Henry Heimlich’s pronouncements lack science.  It is time for Henry Heimlich to admit his speculations are rejected and to stop promoting them.

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Even for choking, the so-called Heimlich Maneuver, or abdominal thrusting, the AHA did not find strong evidence to support it.  It is classified as Evidence Class IIb, of marginal benefit over risk.  It has been found to be on a par with chest thrusts (higher up on the body).  Two scientific papers referenced by the AHA show that chests thrusts are superior and produce higher airway pressures.  Moreover, the AHA links abdominal thrusting to organ damage and requires that a victim be assessed for such if abdominal thrusts were applied.  The AHA further states that more than 50% of foreign body aspirations were not relieved by a single method alone, stating that every method should be used until the obstruction is relieved, back slaps, chest thrusts and abdominal thrusts.  They allow for the continued teaching of abdominal thrusts for clear-cut solid airway obstructions, only since it is easier to learn, not because it is more effective.  The AHA does not recommend abdominal thrusting for choking infants, as severe damage can occur, back slaps are recommended.  Abdominal thrusts are not recommended for pregnant women or obese people.

Once again, based on a critical review of the scientific literature, and resting on principles of medicine and physiology, the pronouncements of Henry Heimlich are found wanting, even for his crown jewel, abdominal thrusting for choking (the so-called Heimlich maneuver).

The physiology of choking is simple, and can be deadly.  A solid foreign object blocks the trachea.  It acts as a ball-valve, letting the victim exhale but not inhale.  The lungs gradually lose air and diminish in size, raising the diaphragm.  Air exchange stops.  Without removal of the object, death can occur.  Abdominal thrusts in some people can squeeze the lungs a bit and produce pressure to expel the object, but scientific studies with actual measurements show that chest thrusts are more effective, as one would expect.  An already raised diaphragm cannot be raised much further to expel air from the lungs.  Squeezing the lungs directly will expel air with more force.  Thus chest thrusts are superior.  And, as the AHA finds, safer.

Henry Heimlich and his spokespeople have regularly stated that “thousands of lives” have been saved by use of abdominal thrusting, and suggest it is the best method for choking.  They have produced no objectively collected, widely accepted data to support the claim. 

One interesting finding that we made in examining claims about the “Heimlich maneuver” was to look at what is actually being taught for the “Heimlich maneuver”..  The results are striking and quite interesting.

We randomly looked at literature and sites on the Internet with drawings of the “Heimlich maneuver” (abdominal thrusts).  The vast majority showed pictures of hands placed not in the abdomen, as Heimlich proposes, but over the diaphragm, (mid-level thrusts) or over the chest itself (chest thrusts).  Thus, it is reasonable to question if all of the claims of success with “abdominal thrusts” are really from abdominal thrusts.  In other words, what is being taught for the “Heimlich maneuver” may abdominal thrusting at all.  Claims of success by the “Heimlich maneuver” may not be from the “Heimlich maneuver”.  A detailed study of this matter should be done.

Henry Heimlich deserves credit for calling attention to the issue of resuscitation for choking, however his suggested method of abdominal thrusting has not been proven, either by science or, apparently, in practice.  Heimlich needs more science and less rhetoric if he and his theories are be believed, or held as credible.  His advocacy of abdominal thrusting for drowning is now officially NOT recommended.  His same technique when applied to choking is marginally effective, and not superior to other methods.

Heimlich has also advocated abdominal thrusting for treating asthma attacks.  Most asthma attacks are spasmodic, in whole or in part, and use of the thrusting is illogical and medically unsound.  No data exist to support abdominal thrusting for asthma.  The immediate use of medications and other proven emergency measures in the hands of trained medical personnel are required. for treating asthma attacks.  Delay in treatment of asthma can be rapidly fatal.

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The issue with Henry Heimlich is not that of a family feud but of scientific integrity.  To their credit Peter Heimlich and his wife Karen have devoted considerable time and effort to focusing on this issue, documenting each step, and, in the tradition of science, putting their data out for all to see.  Their data are right on target, and, as announced today, the American Heart Association agrees. 

In the battle of opinion, ego and personality over science, science always wins,

Robert S. Baratz, MD, PhD, DDS

President, National Council Against Health Fraud
www.ncahf.org

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