Abstract 13807

Introduction: The Heimlich maneuver is a common —yet not always successful—first aid measure for relieving upper airway obstruction caused by choking. Using a choking simulation mannequin, we studied the most effective body position for this maneuver.

Hypothesis: The standing position is not always the best for the Heimlich maneuver.

Methods: The mannequin was connected to a laryngeal model of a child or an adult, and a differential pressure transducer recorded the airway pressure and waveform during the maneuver. A konjac jelly was placed on the larynx to mimic complete supralaryngeal obstruction. The maneuver (5 successive compressions) was performed 6 times each in standing, prone, and supine positions. For cases of children, we added a supine position with a pillow under the back.

Results: In the adult model, airway obstruction was more frequently relieved in the supine and prone positions than in the standing position (all p < 0.001). In the child model, the airway obstruction was relieved significantly more often in the supine position, with a pillow under the back, and in the prone position, than in the standing position (all p < 0.001). Without relief, successive Heimlich maneuvers made the airway pressure increasingly negative (standing position, adult: p < 0.001, standing position and supine position without a pillow, child: p < 0.001 and p = 0.002, respectively).

Conclusions: The Heimlich maneuver was more effective in the supine and prone positions than in the standing position. In children, the prone position may be most effective. Successive Heimlich maneuvers may be harmful when the airway is not relieved after the first compression.