- Email: [email protected]
The need for scientific validation of the data of guildner et al on the chest thrust
f
Correspondence The Need for Scientific Validation of the Data of Guildner et al on the Chest Thrust
creasing complexity t h a t the chest t h r u s t and other modifications t h a t have been adopted have created i n teaching, and in applying, the Heimlich M a n e u v e r by the public.
To the Editor:
I feel sure t h a t Dr. G u i l d n e r et al will wish to clarify this situation further.
In my letter (JACEP, J u n e 1977) on the above subject several points were misstated due to editorial errors. They are:
Trevor Hughes, MB, ChB University of North Carolina Chapel Hill, North Carolina
point 3 should have read "Does the enormous range of the results (eg, 80 to 920 cc of air, with a m e a n (?) of 380 were expressed from the chest with abdominal t h r u s t s in the sitting position) indicate unacceptable v a r i a b i l i t y in the application of the t h r u s t or errors of m e a s u r e m e n t ? " Point 4 should have read ~Were the abdominal t h r u s t s applied i n the m a n n e r presently recommended by Heimlich, or were they given as a 'squeeze' with one h a n d grasping the wrist of the other as the authors i n d i c a t e in another c o m m u n i c a t i o n of the same results?"
Point 5 should have read ~'Would the b i o s t a t i s t i c i a n who helped with the e x p e r i m e n t a l design indicate the steps t a k e n to eliminate subject and e x p e r i m e n t e r bias The paper of Guildner et al (JACEP, September 1976) is an i m p o r t a n t one because it is the scientific basis for ithe inclusion of the chest t h r u s t into the Heimlich Ma~neuver - - a t h e r a p y for choking - - by n a t i o n a l agencies iagainst the advice of Dr. Heimlich and others. Unfortunately, the experiments and the results as recorded do not justify such a step. If this step is to be taken t h e n the authors of the original article have a responsibility to justify them, or at least i n t e r p r e t t h e m so that we can u n d e r s t a n d their significance. It is not sufficient for G u i l d n e r to say (JACEP, J u n e 1977) in reply to the letter by Rosen, ~AI] of the m a n e u vers as described should be s u b m i t t e d to careful ongoing study. The possible complications of all these procedures will evidence themselves as more experience is gained." There is the danger that the results of this e x p e r i m e n t will be a large n u m b e r of people s u s t a i n i n g fractured ribs as Rosen indicated in his letter to J A C E P (June, 1977). F u r t h e r m o r e , G u i l d n e r ' s s t a t e m e n t (JACEP, J u n e , 1977) t h a t ~Dr. Heimlich has requested t h a t his n a m e not be used in connection with the A m e r i c a n H e a r t Association descriptive and teaching materials" is t a k e n out of context. W h a t Dr. Heimlich has said in essence is t h a t he does not wish his n a m e to be associated with dubious modifications of a technique which he invented, developed, and made a v a i l a b l e to the A m e r i c a n public, a t e c h n i q u e ~ which bears his name. As a thoracic surgeon he knows the complications of broken ribs. He'recognizes the in-
J~P
6:11 (Nov) 1977
Author's Reply In reply to Hughes' concerns: (JACEP, J u n e 1977) we a t t e m p t e d to o b t a i n basic i n f o r m a t i o n , w i t h as few variables as possible, on some of the dynamics of the a p p l i c a t i o n of a r t i f i c i a l cough m a n e u v e r s . W h i l e it is recognized t h a t few victims in the field will have a resting functional residual capacity (FRC), the technique chosen obtained as c o n s t a n t a baseline condition as possible. I would point out t h a t further i n v e s t i g a t i o n has been conducted by A. Gordon. Broad based clinical investigation such as t h a t being conducted by the American Heart Association CPR Committee should provide additional valuable information. There is some v a r i a b i l i t y i n the application of the thrusts. This will be the case in actual rescue situations as well. A n effort was made to apply the t h r u s t s as equally as possible. The a b d o m i n a l t h r u s t was applied as described to us by Heimlich by phone and letter comm u n i c a t i o n . There was no i n t e n t to prove or disprove anything. The sudden collapse of a person may be due to stroke, f a i n t i n g , h e a r t attack, drugs, or respiratory depression from some cause other t h a n choking. Many c o m m u n i t i e s t h r o u g h o u t the n a t i o n have already d e m o n s t r a t e d the feasibility and benefits of t e a c h i n g large segments of the population the t e c h n i q u e s of CPR, i n c l u d i n g m a n a g e m e n t of the obstructed airway due to foreign material. There are potential dangers with either abdominal or chest thrusts. The application of the abdominal t h r u s t on the p r e g n a n t mother could be very harmful. The danger of causing damage to a b d o m i n a l organs and the possibility of b r i n g i n g gastric contents up into the airway with application of the a b d o m i n a l t h r u s t may be greater t h a n the danger of fractured ribs caused by the chest thrust. We support the position of the Red Cross and the American Heart Association t h a t both techniques continue to be investigated in field situations.
517/65
Correspondence The Need for Scientific Validation of the Data of Guildner et al on the Chest Thrust
creasing complexity t h a t the chest t h r u s t and other modifications t h a t have been adopted have created i n teaching, and in applying, the Heimlich M a n e u v e r by the public.
To the Editor:
I feel sure t h a t Dr. G u i l d n e r et al will wish to clarify this situation further.
In my letter (JACEP, J u n e 1977) on the above subject several points were misstated due to editorial errors. They are:
Trevor Hughes, MB, ChB University of North Carolina Chapel Hill, North Carolina
point 3 should have read "Does the enormous range of the results (eg, 80 to 920 cc of air, with a m e a n (?) of 380 were expressed from the chest with abdominal t h r u s t s in the sitting position) indicate unacceptable v a r i a b i l i t y in the application of the t h r u s t or errors of m e a s u r e m e n t ? " Point 4 should have read ~Were the abdominal t h r u s t s applied i n the m a n n e r presently recommended by Heimlich, or were they given as a 'squeeze' with one h a n d grasping the wrist of the other as the authors i n d i c a t e in another c o m m u n i c a t i o n of the same results?"
Point 5 should have read ~'Would the b i o s t a t i s t i c i a n who helped with the e x p e r i m e n t a l design indicate the steps t a k e n to eliminate subject and e x p e r i m e n t e r bias The paper of Guildner et al (JACEP, September 1976) is an i m p o r t a n t one because it is the scientific basis for ithe inclusion of the chest t h r u s t into the Heimlich Ma~neuver - - a t h e r a p y for choking - - by n a t i o n a l agencies iagainst the advice of Dr. Heimlich and others. Unfortunately, the experiments and the results as recorded do not justify such a step. If this step is to be taken t h e n the authors of the original article have a responsibility to justify them, or at least i n t e r p r e t t h e m so that we can u n d e r s t a n d their significance. It is not sufficient for G u i l d n e r to say (JACEP, J u n e 1977) in reply to the letter by Rosen, ~AI] of the m a n e u vers as described should be s u b m i t t e d to careful ongoing study. The possible complications of all these procedures will evidence themselves as more experience is gained." There is the danger that the results of this e x p e r i m e n t will be a large n u m b e r of people s u s t a i n i n g fractured ribs as Rosen indicated in his letter to J A C E P (June, 1977). F u r t h e r m o r e , G u i l d n e r ' s s t a t e m e n t (JACEP, J u n e , 1977) t h a t ~Dr. Heimlich has requested t h a t his n a m e not be used in connection with the A m e r i c a n H e a r t Association descriptive and teaching materials" is t a k e n out of context. W h a t Dr. Heimlich has said in essence is t h a t he does not wish his n a m e to be associated with dubious modifications of a technique which he invented, developed, and made a v a i l a b l e to the A m e r i c a n public, a t e c h n i q u e ~ which bears his name. As a thoracic surgeon he knows the complications of broken ribs. He'recognizes the in-
J~P
6:11 (Nov) 1977
Author's Reply In reply to Hughes' concerns: (JACEP, J u n e 1977) we a t t e m p t e d to o b t a i n basic i n f o r m a t i o n , w i t h as few variables as possible, on some of the dynamics of the a p p l i c a t i o n of a r t i f i c i a l cough m a n e u v e r s . W h i l e it is recognized t h a t few victims in the field will have a resting functional residual capacity (FRC), the technique chosen obtained as c o n s t a n t a baseline condition as possible. I would point out t h a t further i n v e s t i g a t i o n has been conducted by A. Gordon. Broad based clinical investigation such as t h a t being conducted by the American Heart Association CPR Committee should provide additional valuable information. There is some v a r i a b i l i t y i n the application of the thrusts. This will be the case in actual rescue situations as well. A n effort was made to apply the t h r u s t s as equally as possible. The a b d o m i n a l t h r u s t was applied as described to us by Heimlich by phone and letter comm u n i c a t i o n . There was no i n t e n t to prove or disprove anything. The sudden collapse of a person may be due to stroke, f a i n t i n g , h e a r t attack, drugs, or respiratory depression from some cause other t h a n choking. Many c o m m u n i t i e s t h r o u g h o u t the n a t i o n have already d e m o n s t r a t e d the feasibility and benefits of t e a c h i n g large segments of the population the t e c h n i q u e s of CPR, i n c l u d i n g m a n a g e m e n t of the obstructed airway due to foreign material. There are potential dangers with either abdominal or chest thrusts. The application of the abdominal t h r u s t on the p r e g n a n t mother could be very harmful. The danger of causing damage to a b d o m i n a l organs and the possibility of b r i n g i n g gastric contents up into the airway with application of the a b d o m i n a l t h r u s t may be greater t h a n the danger of fractured ribs caused by the chest thrust. We support the position of the Red Cross and the American Heart Association t h a t both techniques continue to be investigated in field situations.
517/65