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Cardiopulmonary Resuscitation

Harry L. Gibbons, MD, MPH
JAMA. 1993;269(20):2625. doi:10.1001/jama.1993.03500200039018.
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To the Editor.  —The Heimlich maneuver has saved thousands of persons choking on food or other foreign bodies. American Heart Association (AHA) guidelines1 recommend the Heimlich maneuver to save choking adults and children. However, these same guidelines (page 2259) read: "In the infant a combination of back blows and chest thrusts is recommended for relief of complete foreign-body airway obstruction. Although data are limited in this age group, Heimlich thrusts are not recommended because of fear that abdominal thrusts may cause potentially fatal laceration of the large and unprotected liver."There are no scientific studies supporting back blows or chest thrusts or known published case reports of infants saved by those methods. Of greater importance are the dangers of those techniques. Former Surgeon General C. Everett Koop2 declared back blows and chest thrusts "hazardous, even lethal. A back slap can drive a foreign object even deeper into the


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