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Henry J. Heimlich, MD, ScD
Heimlich Institute Cincinnati, Ohio

JAMA. 1993;269(20):2627.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—The AHA guidelines for CPR¹ recommend treatments for drowning victims that risk lives. The following quotes from the guidelines, page 2246, are in error.

1. "... a Heimlich maneuver should be used only if the rescuer suspects that foreign matter is obstructing the airway or if the victim does not respond appropriately to mouth-to-mouth ventilation." That instruction was contradicted by a guidelines consultant, who, in a study, reported that bystander CPR is not associated with improved outcome in drowning.² No controlled scientific study proves that mouth-to-mouth ventilation increases survival, without first evacuating water from the airway. Yet, mouth-to-mouth ventilation has been the initial drowning treatment for 30 years.
   Patrick (reference 35, page 2250), using a planned protocol for clinical response to drowning, proved that water obstructing the airway of a near-drowning victim is expelled from the lungs by the Heimlich maneuver, enabling recovery.^3,4 Delay caused by prior mouth-to-mouth
   

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