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May 26, 1993

Cardiopulmonary Resuscitation

Author Affiliations

Heimlich Institute Cincinnati, Ohio

JAMA. 1993;269(20):2627. doi:10.1001/jama.1993.03500200039022

To the Editor.  —The AHA guidelines for CPR1 recommend treatments for drowning victims that risk lives. The following quotes from the guidelines, page 2246, are in error.

  1. "... a Heimlich maneuver should be used only if the rescuer suspects that foreign matter is obstructing the airway or if the victim does not respond appropriately to mouth-to-mouth ventilation." That instruction was contradicted by a guidelines consultant, who, in a study, reported that bystander CPR is not associated with improved outcome in drowning.2 No controlled scientific study proves that mouth-to-mouth ventilation increases survival, without first evacuating water from the airway. Yet, mouth-to-mouth ventilation has been the initial drowning treatment for 30 years.

    Patrick (reference 35, page 2250), using a planned protocol for clinical response to drowning, proved that water obstructing the airway of a near-drowning victim is expelled from the lungs by the Heimlich maneuver, enabling recovery.3,4 Delay caused by prior mouth-to-mouth