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May 26, 1993

Cardiopulmonary Resuscitation-Reply

JAMA. 1993;269(20):2627. doi:10.1001/jama.1993.03500200039023

In Reply.  —Our study does not contradict the AHA guidelines recommending the Heimlich maneuver for use only for suspected foreign body obstruction in the submersion victim.1 While bystander CPR was not associated with improved outcome in drowning, the majority of study victims (78%) had received bystander CPR, making comparison difficult between the bystander and no-bystander groups. Moreover, these two groups included victims with both short and long submersion durations. Most submersion victims' fates are determined by the duration of their submersion; we recommended that future studies evaluating an intervention should assess and control for submersion duration.The statement that there are no controlled studies supporting CPR in submersion victims is incorrect. A recent study compared the outcome of submersion victims treated with varying degrees of CPR and controlled for submersion duration.2 All victims receiving some degree of CPR did better than those who had none; the ones who