Choke

A compelling story, even if factually inaccurate, can be more emotionally compelling than a dry recitation of the truth.

If you have ever found yourself gasping for air and suddenly been bear-hugged from behind by a waiter, his fist, placed just below your sternum, dislodging the food blocking your trachea with one miraculous thrust, you owe the waiter a large tip, but you owe your life to Dr. Henry Heimlich.

He's the maneuver man, credited for three decades as the inventor of the simple, anyone-can-do-it technique for saving the lives of dinner companions who have just begun pointing furiously at their throats while turning blue.

Or at least that is the way that it works in the movies.

In real life there is little evidence to support the assertion that the Heimlich manovuer actually works.

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Dr. Heimlich's first claim to medical fame was a surgical technique that involved replacing a patient's damaged esophagus with a gastric tube. In 1955 Heimlich had published a paper in the journal Surgery describing how he had performed the operation on dogs. A Romanian physician, Dr. Dan Gavriliu, wrote to Surgery to point out that he'd been performing the same operation successfully on humans for four years.

At the 1985 American Heart Association conference, at which a panel of experts in each safety field would decide whether new evidence warranted new recommendations for approved actions in emergencies, the Heilich Maneuver was to be considered. The chairman of that conference, Dr. Bill Montgomery, knew that Heimlich was prepared to do battle with the committee on the topic of choking.

"It was this huge publicity campaign. He was something to be reckoned with," Montgomery recalls. "He threatened to sue us all and write to the presidents of our universities. It was brazen, terrible, unusual."

Different studies reached different conclusions about the most effective method for choking intervention: the Heimlich maneuver, back blows, or chest thrusts, which consist of pushing down on the victim's sternum, as with CPR. There was a dearth of data. As one panel member, Dr. James Atkins, summarizes the situation, the committee could "adopt something that has no evidence, something that has very poor evidence, or something that has mediocre evidence."

Heimlich's evidence might have been even less persuasive, however, had he informed the panelists that his own foundation had financed the one study demonstrating the superiority of the Heimlich maneuver. In fact, they didn't learn this until 20 years later.

Heimlich's rivals folded.

Dr. Archer Gordon, the advocate of back blows, was too scared even to show up at the conference.

Dr. Charles Guildner, the champion of the chest thrust theory, didn't back down so easily, leading Heimlich to make good on his threats: Heimlich accused Guildner of unethical medical practices and petitioned to have his license stripped. Says Guildner, "He tried to bury me.

The panel ruled for the Heimlich maneuver.

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There is, however, one significant problem.

There is actually very little or no evidence to support the Heimlich manoeuvre and the literature is awash with reports of harm and this includes things such as fractured sternums, ruptured livers and other serious consequences of this Heimlich manoeuvre.

Apart from a few case reports there is no other evidence to support what Henry Heimlich has advocated. There's no published data of any substantial nature except for a few case reports and lots of TV programs and there were substantial reports in the literature of harm.

By the late 1980s Henry Heimlich's anti-choking maneuver was world famous, and he was publicly musing over the question, what next? His first priority was establishing the Heimlich maneuver's use in drowning rescue, in lieu of CPR. Second, he vowed he could cure AIDS by treating HIV-positive patients with malaria. He even considered running for president in order to bring world peace.

The maneuver-for-drowning campaign was based on the premise that water must be forced out of the lungs. "You can't blow air into water-filled lungs," according to Heimlich's slogan.

There's just one problem with that thesis. "The idea that inhaled water fills up the lungs in drowning is totally incorrect," says Rear Admiral Alan Steinman, who crafted the U.S. Coast Guard's guidelines for cases of near-drowning. Steinman said that an involuntary response, laryngospasm, seals the lungs at the moment fluid threatens to flow in. Only a very small amount of water ultimately gets into the lungs after the spasm relaxes.

Employing the Heimlich maneuver may be not only ineffective but lethal, according to Dr. James Orlowski, another drowning expert. In 1987 Orlowski published a paper describing a 10-year-old drowning victim who had suffered complications from the rescuer's use of the Heimlich maneuver rather than CPR. A boy who might have been saved slipped into a coma and later died.

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Despite his lack of independent evidence, Heimlich had credibility with the public and the media.

And perhaps – that is all that one needs these days to be heard and believed.