Life

When Dr. Henry Heimlich urges people to use Heimlich maneuver as the first step in drowning rescues, he makes two persuasive points. Water has to come out of the lungs before air can get in, he says, and studies have found survival rates of 97 percent when the Heimlich maneuver is used first but 58 percent otherwise.

His many critics dismantle each point, however. They question whether Heimlich understands either how people drown or what constitutes credible research. Those critics are virtually unanimous among the countless experts in the medicine and mechanics of drowning who've gone public, thoroughly documenting their challenges to both the data he cites and the rescue examples he gives.

Nobody disputes the first priority in saving someone from drowning. It's getting air into the lungs so oxygen can reach the bloodstream and brain.

Standard-setting authorities on five continents have determined the best way to do that is to begin mouth-to-mouth rescue breathing as quickly as possible. They cite studies showing inhaled water won't interfere, and the Heimlich maneuver is more likely to create problems than solve them. They specify two main risks:

• "If you give the Heimlich maneuver first, then every second that goes by without breathing oxygen into the lungs, brain cells and body cells are dying," said Dr. Alan Steinman, who has been the Coast Guard's chief medical officer and a member of panels that set rescue protocols.

• The maneuver also increases the chances of vomiting, Steinman said. Acidic stomach contents "can do tremendous damage to the lungs" when drowning victims resume breathing, he said. They reflexively swallow so much water that vomiting is common in any rescue. "But if you do the Heimlich, you're guaranteeing it."

They're ignoring "scientific facts," Heimlich said repeatedly of the American Heart Association. It publishes the rescue guidelines of the International Liaison Committee on Resuscitation, which comprises the American, European, New Zealand and Australian, Canadian, South African and Inter-American rescue organizations.

"It's this old business of not wanting to make the changes and say they've been wrong all these years," Heimlich said.

Taking Heimlich's contentions one at a time:

Must water be removed for oxygen to reach the lungs of a drowning person?

No, say autopsies and basic physiology. Drowning people do inhale water, but not for long. When the airway recognizes something that doesn't belong there, the larynx goes into a spasm that closes it, said Dr. Robert Baratz, a longtime emergency medicine practitioner and the president of the National Council Against Health Fraud.

That's why people cough when they drink something that "goes down the wrong pipe."

Even when water is in the airway, research shows it doesn't wall out oxygen. The Institute of Medicine and the American Red Cross found "no evidence in any study that removing water from the lungs will alter this sequence of events."

Is the Heimlich maneuver usually successful in drowning rescues?

The maneuver's 97 percent success rate speaks for itself, Heimlich said. Jeff Ellis & Associates' lifeguards work at public pools and theme parks across the country, and they succeeded in 147 of 152 drowning rescues when the maneuver was their first step in 1995-99.

"But we don't have any data to show that it worked any better than the traditional model did," Ellis consultant Lawrence Newell said in 2001, a year after Ellis lifeguards began using the maneuver only if rescue breathing fails. Nor has Ellis' data been scrutinized independently.

The American Red Cross reviewed 18 drowning studies addressing the Heimlich maneuver for a report in 2000. Seven of the studies made recommendations — all for the rescue breaths and chest compressions of CPR. Only five recommended the Heimlich, even if something solid blocks the victim's airway.

How safe and effective is CPR in drowning rescues?

Heimlich's source for the poor 58 percent success rate of breathing-first rescues is a 1980s study of Seattle-area pools by pediatric drowning specialist Dr. Linda Quan of Seattle Childrens Hospital and the University of Washington. Quan characterized those lifeguards more as mere attendants, however — ticket and hot dog vendors not trained in CPR.

"The only fact I have is that she looked at lifeguards in public swimming pools and found 42 percent deaths," he said. "I haven't seen any studies done since they had good training."

Quan's follow-up report on Seattle's public pools appeared a year later in the 1990 Journal of Environmental Health. A decrease in drownings and near-drownings correlated with an increase in lifeguards who were trained in CPR's rescue breathing and chest compression.

"His mischaracterization, in print, was grossly misleading and defines his character," Quan said, preferring otherwise to let her writings speak for her.

Some people do recover from drowning after use of the Heimlich maneuver, Baratz said. They can recover from pneumonia after taking Lipitor (a cholesterol medication), too. It doesn't mean Lipitor cured it.

"The point is that the Heimlich maneuver might produce harmful effects, and it will delay the proper treatment," Baratz said. "Fundamentally, Heimlich's pronouncements about drowning are medically wrong."

Contact this reporter at (937) 225-2129 or klamb@DaytonDailyNews.com.