International Life Saving Federation

Near drowning victims present unique and challenging problems in airway management because of the nature of the episode. Since drowning is a process of asphyxiation, the victims are usually profoundly hypoxic. They have often swallowed large quantities of water and air; their stomachs frequently contain food and drink consumed just prior to entering the water.

This combination of hypoxia and a full stomach is the cause of the regurgitation that is very familiar to lifeguards and is an almost inevitable accompaniment of near drowning. This has been well documented in the literature. 1 2 3 4 5 6 7 8 9

Submersion victims may aspirate some fluid into their lungs but there is no evidence that this can or need be removed by any technique.

The priority for rescuers is to implement resuscitation at the earliest possible opportunity. In doing this, the maintenance of a clear airway and prevention of aspiration are of paramount.

The Medical Commission of the International Life Saving Federation has carefully considered the particular problems of upper airway management in near drowning. Techniques which have poor efficacy and purely anecdotal support are strongly discouraged. Abdominal thrusts (Heimlich Maneuver) to relieve airway obstruction have been carefully considered and the following conclusions drawn:

• In near drowning upper abdominal thrusts pose a great risk of precipitating gastro-oesophageal regurgitation and subsequent inhalation of stomach contents into the lungs.
• There is no clear medical rationale for its use and in particular it seems clear that the manoeuvre cannot expel sufficient water from the lower portions of the respiratory tree to aid in resuscitation.
• There are no well controlled blind studies to validate its value in near drowning.
• The use of abdominal thrusts as a first maneuver will merely serve to delay the institution of appropriate cardiopulmonary resuscitation which has been well proven to save life in this condition

Therefore the Medical Commission of the International Life Saving Federation strongly recommends that in cases of near drowning the use of upper abdominal thrusts is contraindicated unless a solid foreign body (not water) is present in the upper airway and cannot be dislodged by other means. This would be demonstrated by inability to obtain adequate ventilation of the lungs in the course of basic resuscitation measures.

1. 1. Manolios N & Mackie I, Drowning & near drowning on Australian beaches patrolled by lifesavers: 10 year study 1973-1983. Med J Aust Vol 148 February 15, 1988.
2. 2. Modell J H, The Drowning Process and Lifeguard Intervention, Proceedings of the International Medical Rescue Conference San Diego, September 15-17, 1997.
3. 3. Heimlich H J, Patrick E A: Using the Heimlich Manoeuvre to Save Near-Drowning Victims. Postgrad med, 84: 62-27, 71-73., 1988.
4. 4. Standards and Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC). JAMA, 255: 2905-84., 1986.
5. 5. Rozen P, Stoto M, Harley J, (eds): The use of the Heimlich Manoeuvre in Near-Drowning. Committee on the Treatment of Near-Drowning victims. Division of Health Promotion and Disease Prevention. Institute of Medicine, Washington, D.C., August 1994.
6. 6. Orlowski J P: Vomiting as a Complication of the Heimlich Manoeuvre. JAMA, 258: 512-513, 1987.
7. 7. Orlowski J P: Drowning, Near-drowning and ice-water submersions. Pediatric Clinics of North America. Vol 34 No 1 February 1987.
8. 8. Heimlich H J: Subdiaphragmatic pressure to expel water from the lungs of drowning persons. Ann Emerg Med 10 (9): 476-480, 1981.
9. 9. Orlowski J P: Heimlich manoeuvre for near-drowning questioned. Ann Emerg Med 11 (2): 111-113, 1982.