Doctor's Review: Medicine on the Move

April 23, 2017

Dr Henry Heimlich demonstrates his manoeuvre on Johnny Carson while appearing on The Tonight Show in April 1979.

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A man and his manoeuvre

Heimlich choked by his ambition

President Ronald Reagan was nearly felled by a peanut. A vitamin pill almost took down pop icon Cher. And former New York Mayor Ed Koch was reputed to have narrowly escaped death by watercress. What saved them? A procedure so simple a child can perform it, so familiar everyone’s heard of it: the Heimlich manoeuvre.

Most Canadians have seen the “First Aid for Choking” posters that have appeared on restaurant walls since the ‘70s detailing the mechanics of the Heimlich manoeuvre: stand behind the choking victim, wrap your arms around them, place a fist one hand above the bellybutton, clasp it in the other fist, and pull inwards and upwards.

Many have performed the manoeuvre themselves, or know someone whose life was saved by it. The Good Samaritan tool is not an ancient relic from medical history, but rather reported to be the inspiration of Henry Heimlich, a man who is alive and well today at age 96. And although his name is a household word, Heimlich believes that forces are conspiring to erase it from collective memory. He may have a point.

Below the rosy surface of a procedure that has unquestionably snatched many a soul from “café cardiac,” as it was once known, lies a raging family feud and an unresolved medical debate. Evidence of an official cooling off towards the Heimlich legacy can be found in revised language about the procedure, which has been renamed “abdominal thrusts” by both the American and Canadian Red Cross.

In 1974, when Dr Heimlich developed the procedure, people were so eager to learn from him that he was able to circumvent the fact-based medical realm and popularize his manoeuver based entirely on anecdotal evidence. Choking claimed thousands of lives each year and no one knew how to stop the death toll. Doctors fiddled with near-useless inventions such as the Throat-E-Vac, a mini-suction device intended to suck the food obstruction form a person’s throat, and the ChokeSaver, a 23-cm-long pair of plastic tweezers meant to do the same, but the dubious products did not catch on.

For years, incidents of public choking had been misinterpreted as cardiac arrests. In 1963, a Florida coroner named Robert Haugen published an article casting light on the so-called heart-attacks that were claiming the lives of thousands of restaurant goers every year. Examining the airways of several of the deceased, he located “steak in four cases, beef in two, ham fat in one, kippered herring in one, and broiled lobster in another” and pronounced death by asphyxiation. He dubbed the phenomenon “the café coronary.”

Surgeon-inventor

In 1969, Dr Heimlich, then director of surgery at the Jewish Hospital in Cincinnati, had spent his career thus far saving and improving lives with inventions, both his own and those of others. In the mid-50s, he began to employ a surgery that allowed people with severe esophageal damage to swallow food. In 1963, he invented a “flutter valve” which allows blood to be drained from a chest cavity so that a collapsed lung can re-expand. He was eager to address the problem of choking.

As a thoracic surgeon, he knew that lungs contained a substantial amount of air at the moment of choking and he hoped to use that air to expel the object lodged in the larynx. In the animal lab at his hospital, he partially anesthetized a 17-kilogram beagle and lodged a cuffed endotracheal tube in the dog’s larynx. First, he pressed on the dog’s chest with no results. Next he pushed up on the diaphragm and found that he could compress the lungs that way. To his delight, the tube flew out. He replicated the experiment, this time with chunks of hamburger meat, on three other dogs.

Still, the doctor had no way of knowing whether his technique would work on humans. His solution? He convinced the editor of Emergency Medicine, a journal that did not require its articles to be peer-reviewed, to permit him to print his proposal for the anti-chocking treatment in its pages. Readers were urged to attempt the method should an emergency choking event arise and report their results to him. Dr Heimlich then sent a copy of the article to Arthur Snider, the Chicago Daily News’s nationally syndicated science writer.

Just a week later, Dr Heimlich got what he was hoping for: in Washington state, a retired restaurant owner had used the procedure to prevent his neighbour from choking to death. More news articles ensued and anecdotal evidence continued to pour in. Before long, the American Red Cross was recommending that the manoeuvre be used alongside slaps to the back. At Heimlich’s urgings, the slaps to the back, which Heimlich called “death blows,” insisting that they lodged food even farther into the throat, were dropped from the recommendations. By 1986, Heimlich’s manoeuvres were widely recognized in North America as the single most effective way to save a person from death by choking.

In recounting this story as he has done many, many times, Dr Heimlich never mentions his colleague, Dr Edward Patrick, who claims to have collaborated with him on the manoeuvre and its popularization for more than two decades. Though Dr Heimlich sticks resolutely by his assertion that he and he alone came up with the method, Dr Patrick says that the two developed it together. Over the years, Dr Patrick says he was a tireless promoter of the manoeuvre and was instrumental in gaining public acceptance.

Bad old dad

Dr Patrick isn’t the only person to have challenged Dr Heimlich’s claim to fame. Since 2002, Dr Heimlich’s son Peter, and his wife Karen, have dedicated much of their time to defaming his dad. Peter Heimlich has accused his father of medical fraud and quackery as well as carrying out horrific experiments on human subjects. Peter admits that it was a private family conflict that prompted him to go digging for dirt, but that what he found there was so shocking that he felt an “ethical responsibility” to broadcast it to the world.

Heimlich the Younger says that the fame his father received from the success of the manoeuvre went to his head and made him hungry for more attention. In an attempt to further dominate the field of emergency response procedures, Peter says his father declared that the Heimlich manoeuvre could be used for a range of other conditions including stopping asthma attacks, curing cystic fibrosis and clearing water from the lungs of drowning victims. The later claim was particularly heinous, says Peter, as it has been demonstrated that use of the Heimlich manoeuvre on a drowning victim can delay resuscitation efforts and induce vomiting, resulting in aspiration pneumonia.

These inflated claims were not the only dodgy business Dr Heimlich cooked up, says Peter, who has devoted an obsessively researched and detailed website to what he sees as his father’s iniquity. Perhaps the most egregious of his father’s activities is his involvement in malaria therapy, a theory that posits that injecting people who have AIDS, or even cancer, with malaria and letting the illness run its course for three weeks before stopping it with medication will kill the AIDS virus and eliminate cancer. When Dr Heimlich was denied permission to conduct malaria therapy research on human subjects in the US, he set up labs in Mexico, Africa and China, and received generous funding from Hollywood stars.

Dr Heimlich remains publicly passionate about malaria therapy, though his overseas research came to a halt years ago, in part to his son’s agitating. The doctor is dismayed that ER organizations, including Red Cross Canada, have demoted the significance of the Heimlich manoeuvre and now refer to it simply as “abdominal thrusts.” But he takes comfort in the stories that continue to roll in, week after week, month after month, of what he dubs “Heimlich Heroes,” people of all ages who have experienced the joy of saving a life. No one can argue with him about that.

Incidentally, the manoeuvre has never been used in Australia. The general belief Down Under is that its risks outweigh its benefits. The primary injury associated with the manoeuvre is gastric rupture, but other injuries include lacerated liver, fractured sternum, aortic valve cusp rupture and aspiration of stomach contents. The Aussies also contend that chest thrusts (resus.org.au/faq/choking) have been proven to be not only less risky, but more effective, and seem puzzled that so much of the world has embraced a procedure with so little scientific backing as the Heimlich manoeuvre.

Canada, the US and the UK have taken a different route. The most common advice in the case of a chocking victim is to first use five sharp back slaps and, if they don’t dislodge the object, only then go on to “abdominal thrusts.” The Red Cross continues to support the thrusts if only because people find them easy to remember.

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