Cardiopulmonary Resuscitation-Reply

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