proper CPR for drowning victims

Factual Questions
1

Long Introduction:

My local news had a segment the other night talking about CPR for drowning victims and training that lifeguards get for working at community pools and whatnot. The story said that one of the major lifeguard certification agencies trains lifeguards in a technique that is “unsafe” and not recommended by the American Red Cross or doctors.

The technique in question is to perform five abdominal thrusts (i.e. Heimlich Maneuver) on the victim prior to beginning chest compressions (CPR).

The reporter spoke with the Red Cross and some doctor and was told it wasn’t recommended and to proceed with chest compressions right away. The reporter tried contacting the guy who runs the certification agency, and tracked him down at his home. That interview was not handled well by the guy.

What he could have done was said, “I’d prefer not to talk on my porch, but call the office number and set up an appointment and I’ll be happy to address your concerns,” or perhaps “I’d rather not speak on camera until I consult with an attorney,” or even “No comment”. Instead, he chose to launch into a tirade, calling the Red Cross imbeciles stuck in the 1950s and getting rude, insulting, and nasty with the reporter.

Or he could have actually explained the concept, as below.

They also commented that the State of Utah made them send out a notice to all lifeguards trained there to not do the abdominal thrusts. The State of Texas apparently doesn’t have state licensing or state control over lifeguard training, so they don’t have any way to enforce a change currently.

General Question:

The thing about drowning victims is that they typically have their lungs full of water. The point of CPR is to circulate oxygenated blood to keep the brain alive. However, having the lungs full of water will prevent oxygen from getting into the blood, so the chest compressions would be pointless and counterproductive until the lungs are cleared of water. I would think the intent of the abdominal thrusts is to clear the lungs.

So my question is what is the recommended procedure for clearing the lungs, if not abdominal thrusts? Turn them on their side or stomach for a minute to let the water drain? That isn’t starting compressions immediately. Using the chest compressions to squeeze out the water? While that will provide some lung bellowsing and is why the recommended technique for CPR has largely dropped rescue breathing in favor of maintaining chest compressions, that seems unlikely to be fully effective in clearing the lungs, and delay the ability to oxygenate the blood.

Why not use abdominal thrusts? It’s safer than chest compressions, which often break ribs.

2

Why not use abdominal thrusts? Because they’re of no proven benefit. While CPR is of proven benefit for drowning victims. Ventilation is of the utmost importance for drowning victim resuscitation, and chest compressions provide ventilation.

Unfortunately Dr. Heimlich has turned into a bit of a crank after gifting us with his maneuver, which does save people with solid airway obstructions. But he’s been advocating quite forcefully for using it on a whole bunch of folks for issues it has no proven benefit for, such as drowning victims, people with asthma attacks, etc.

3

Can I ask a related question? Sometimes in old movies or books you see them “pumping” drowning victims by moving their arms up and down, presumably in an attempt to get the water out of their lungs. Did that do anything useful, even as an accidental sideways chest compression?

4

It was the back pressure armlift method of CPR. Firt time I took CPR more then 40 yrs ago I was taught it v. mouth to mouth.

5

Time is of the essence and two inch chest compressions done at a rate of 100 compressions per minute will expel water from the lungs–perhaps not all of it, but they will get things going. Heimlich thrusts will not move blood through the brain. Besides, there may not be any water in the lungs to begin with.

6

Dumb question, but why not just raise the victim by their feet for a few seconds to something of an upside down position to let the water drain out of their lungs?

7

Ever try to lift someone completely off the ground by their feet?
You’re looking at 125 -250 lbs or even more all by yourself(perhaps). It’s not just raising their feet, you need to elevate the torso.

8

Drowning victims should be taken to the morgue, just like murder victims, electrocution victims, decapitation victims, etc. … 'cause, you know, they’re, like, all dead 'n stuff.

</grammar Nazi>

9

What should we call people who almost drown but survive? Attempted drowning victims?

10

You do not need to have died to become a drowning victim.

11

Because there’s no proven benefit, and time is of the essence, ventilation being the most important thing to accomplish when attempting to save a drowning victim. CPR ventilates the victim; raising their feet does not.

12

The blood will still have some unexpended oxygen in it. Chest compressions circulate that blood which helps prevent heart muscle and brain cells from dying.

CPR training has been changed quite recently to emphasize chest compression over ventilation.

13

I’ve noticed that, but I was unsure whether it was because it’s actually better, or just because it’s simpler. A slightly-suboptimal procedure that people actually learn, remember, and do might be better than an optimal procedure that most people forget or give up on.

14

the compressions both circulate and ventilate.

15

According to Merriam Webster you do. Here.

16

Good for them. They don’t control how English words are used.

17

:dubious:

Just because you’re a pulseless non-breather (aka dead) doesn’t mean you have to stay that way. What do you think they invented CPR for?

18

True, but lets not get over excited about it. Studies have shown it’s success rate to be below 10% and sometimes below 5%.

There is actually a nationwide study going on that most people are unaware of. Some agencies are being instructed to conduct CPR one way and others another way. And the only way (wait till you hear this!) to assure responders use the old method on you is if you call your local EMS/fire/police and tell them you want to opt out of the study. This is for that big emergency you know you’ll have someday. :rolleyes:

I just learned of this study when I was re-certifying and am having difficulty finding a cite on it. Our instructor told us so far in Milwaukee County only a dozen people have opted out. But that’s probably because nobody knows about it!

19

Thanks for the article. It provides the info I needed:

So a nearly dead person who drowned may not have actually inhaled much water? That’s interesting. I thought one of the key problems with drowning was trying to inhale but not being able to get your head above the surface, and thus inhaling water instead of air. Is it instead passing out from lack of oxygen while trying to hold breath underwater and gasping ineffectively when breaking the surface?

Anecdote: my dad said he’s done resuscitation twice in his life on dead people. One incident involved a teenager who drowned and was under water for some substantial time - 30 minutes? An hour? They pulled him out and he was blue, but dad had to try. He was a teenager then.

The second incident was a scoutmaster who had a heart attack playing a game of pickup baseball with the kids. Again, he tried resuscitation until the paramedics arrived. He died, too.

Both times were pre-heart compression CPR.

Two factors. One, people are kinda skeeved about mouth to mouth, especially with AIDS and whatnot. More importantly, in order to do rescue breathing, you have to cease heart compressions. For one person doing CPR and rescue breathing alone, this can be significant in time spent shuffling between the torso and bending over the face and tilting the head back. Even with two people, breaking the chest compression routine is counterproductive.

Chest compressions squeeze the ribcage, and thus squeeze the lungs. Rebounding of the chest rebounds the lungs. Thus chest compressions provide some natural bellowsing of the lungs to get fresh air into the lungs, and thereby oxygenate the blood.

The point of CPR is not to restart the heart. This is a common fallacy promoted by movies where they do CPR and try to get the heart started again, the victim breathing, etc. Including old-style pounding on the heart. No. The purpose of chest compressions is to keep oxygenated blood circulating through the brain to stave off brain death until medical help can arrive and a defibrillator can be used.

And yes, it is still a low probability of success, but I know a guy that it did work on. He keeled over in an office conference room, someone in the building started CPR quickly, and the ambulance arrived fairly quickly. Last I know he was alive, but I haven’t seen him in a couple years, but that incident was 10 years ago.

So a person has been suffocated by submersion in water and ceased breathing and their heart stopped. Thus, drowning victim. However, it was moments ago, so CPR is commenced in the hope of keeping blood circulating until a defibrillator can be tried and hopefully restart the heart.

20

Her’s how to do it: - YouTube

We had this nightly on our TV for ages