"Pop Goes the Cafe Coronary" by Henry J. Hemlich MD, Emergency Medicine, June 1974
ozoffy...@yopmail.com
Medicine, June 1974
Every year in the United States, 3900 healthy people strangle on food
stuck in their tracheas. That’s more people, by the way, than are
killed each year in accidental shootings.
The incident generally occurs at the dinner table. The victim suddenly
chokes, turns blue or black, and is dead in minutes. He can neither
speak nor help himself. And chances are no one else will help him
either since bystanders frequently confuse the episode with a heart
attack. Thus the popular appellation "cafe coronary."
Appropriate treatment, of course, is tracheostomy or insertion of a
large-caliber hypodermic needle into the trachea to provide a
temporary airway. Recently an instrument for removing the food from
the buck of the throat has been described. To have this instrument
available or someone skilled at tracheostomy on the spot at the lime
of this dire emergency would he fortuitous but rare indeed.
What's really needed then is a first aid procedure that doesn't
require specialized instruments or equipment and can be performed by
any informed layman - or even considered by a physician before
resorting to tracheostomy with its attendant hazards. So,
experimentally at least, I have developed such a procedure. It's been
tested only on dogs but I believe the logic of the concept and the
favorable findings warrant public dissemination.
Since aspiration must occur during inspiration in order for the bolus
to be sucked against the laryngeal orifice, the victim's lungs are
expanded at the time o f the accident - actually there is always
residual air in the lung - so sudden forceful compression of the lungs
will increase the air pressure within the trachea and larynx and thus
eject the offending bolus like the cork from a champagne bottle.
There, in short, are the dynamics of the procedure. And here's how to
do it:
Standing behind the victim, the rescuer puts both arms around him just
above the belt line, allowing head, arms, and upper torso to hang
forward. Then, grasping his own right wrist with his left hand, the
rescuer rapidly and strongly presses into the victim's abdomen,
forcing the diaphragm upward, compressing the lungs, and expelling the
obstructing bolus. The same effect can be obtained with the victim
lying face down on the floor, the rescuer sitting astride the victim's
lower torso or buttocks.
If, however, the victim is already lying on his back, he needn't be
moved. The rescuer merely sits astride him and suddenly presses both
hands - one on top of the other - forcefully into the upper
subdiaphragmatic abdominal region.
A second person should be prepared to remove the ejected food from the
victim's mouth - particularly if he's on his back - with a spoon or
fingers.
The procedure is adapted from experimental work with four 38-pound
beagles, in which I was assisted by surgical research technician
Michael H. McNeal. After being given an intravenous anesthetic, each
dog was "strangled" with a size 32 cuffed endotracheal tube inserted
into the larynx. After the cuff was distended to create total
obstruction of the trachea, the animal went into immediate respiratory
distress as evidenced by spasmodic, paradoxical respiratory movements
of the chest and diaphragm. At this point, with a sudden thrust. I
pressed the palm of my hand deeply and firmly into the abdomen of the
animal a short distance below the rib cage, thereby pushing upward on
the diaphragm. The endotracheal tube popped out of the trachea and,
after several labored respirations, the animal began to breathe
normally. This procedure was even more effective when the other hand
maintained constant pressure on the lower abdomen directing almost all
the pressure toward the diaphragm.
We repeated the experiment more than 20 times on each animal with the
same excellent results When a bolus of raw hamburger was substituted
for the endotracheal tube, it, too, was ejected by the same procedure,
always after one or two compressions.
We cannot be certain, of course, that the experimental results will be
duplicated in humans. But when tracheostomy is no feasible, there is
certainly no risk in recommending that the procedure be tried in
actual cafe coronary emergencies since an unaided victim will die in
minutes Then, as experiences are reported, the method can be
evaluated. Only by disseminating public information about this simple
technique can we determine whether it will result in a significant
reduction of what amounts to 3900 totally avoidable deaths every year.
Should you use, or learn of anyone, using, the Heimlich method, by the
way, please report the results either to EM or to me.
---
Dr. Heimlich is director of surgery and physician-in-chief of the
esophagus center at the Jewish Hospital and associate clinical
professor of surgery at the University of Cincinnati College of
Medicine.
@1974, Emergency Medicine
