Elsevier

Resuscitation

Volume 39, Issues 1–2, November 1998, Pages 129-131
Resuscitation

An interesting complication of the Heimlich manoeuvre

https://doi.org/10.1016/S0300-9572(98)00109-9Get rights and content

Abstract

The removal of inhaled foreign bodies using the Heimlich manoeuvre is recommended as part of the immediate management of the choking child. We report on a case of witnessed laryngeal obstruction by a foreign body in which repeated Heimlich manoeuvres failed to expel the foreign body, but temporarily relieved the obstruction. The repeated Heimlich manoeuvres dislodged the foreign body into the trachea and may have contributed to the rapid development of extensive surgical emphysema, pneumomediastinum and pneumopericardium. The purpose of this report is to demonstrate that the Heimlich manoeuvre was effective in relieving the airway obstruction, but was associated with potentially severe complications.

Introduction

The removal of inhaled foreign bodies using the Heimlich manoeuvre is recommended as part of the immediate management of the choking child [1]. However, airway obstruction due to infections such as acute epiglottitis or croup requires urgent transfer to a hospital setting and attempts to clear the airway with physical methods are dangerous. We report on a case of witnessed laryngeal obstruction by a foreign body in which repeated Heimlich manoeuvres temporarily relieved the obstruction, but failed to expel the foreign body. The Heimlich manoeuvres dislodged the foreign body into the trachea and may have contributed to the rapid development of extensive surgical emphysema, pneumomediastinum and pneumopericardium.

Section snippets

Case report

A healthy 7-year-old boy, while playing at home, suddenly presented red-faced and panicking to his mother. He was holding a pen and gesturing to his neck. His mother correctly understood that he had either inhaled or ingested the lid of the pen. She immediately tipped him upside down and slapped him on the back, but this proved ineffective. She then performed the Heimlich manoeuvre three times. These actions did not dislodge the object and although the boy remained fully conscious, he started

Discussion

In 1975 Heimlich published a landmark study on the use of the abdominal thrust technique for the resuscitation of food choking victims 2, 3. The Heimlich manoeuvre has since been found to be a useful method for removing aspirated foreign bodies from the airway. However, several complications have been reported with the use of the Heimlich manoeuvre. These complications include stomach rupture [4], aortic valve rupture, diaphragmatic rupture, oesophageal rupture, jejunal rupture, mesenteric

References (11)

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