Heimlich Manevrası
Özet
Trakeobronşiyal yabancı cisim aspirasyonu (YCA), özellikle bebekler, küçük çocuklar, yaşlı bireyler ve risk gruplarında ani hava yolu tıkanıklığına neden olarak yaşamı tehdit eden acil durumdur. Heimlich manevrası, 1974’te Dr. Henry Heimlich tarafından tanımlanan ve pozitif intratorasik basınç oluşturarak hava yolunu açmayı amaçlayan etkili bir ilk yardım yöntemidir. Günümüzde Amerikan Kalp Derneği (American Heart Association, AHA) ve Avrupa Resüsitasyon Konsey (European Resuscitation Council, ERC) gibi otoriteler, çocuk, erişkin, gebeler ve obez bireylerde farklı uygulama algoritmalarını önermektedir. Manevra sırasında diyaframa uygulanan ani abdominal bası, güçlü bir hava akımı oluşturarak yabancı cismin dışarı atılmasını sağlar. Ancak mide rüptürü, aort diseksiyonu, dalak ve karaciğer laserasyonu gibi ciddi komplikasyonlar gelişebilmektedir. Başarısız durumlarda rijit veya fleksibl bronkoskopi ile girişim yapılması gerekebilmekte, LifeVac ve DeChoker gibi negatif basınçla çalışan cihazlar, belirli durumlarda alternatif yöntemler olarak kullanılabilmektedir. Simülasyon temelli eğitimler ve teknolojik gelişmeler, doğru ve güvenli uygulamayı desteklemektedir. Heimlich manevrası, yalnızca acil durumlar değil, halk sağlığı ve eğitim de önemli bir yere sahiptir.
Referanslar
Heimlich HJ. A life-saving maneuver to prevent food-choking. JAMA. 1975;234(4):398–401.
Pavitt MJ, Swanton LL, Hind M, et al. Choking on a foreign body: a physiological study of the effectiveness of abdominal thrust manoeuvres to increase thoracic pressure. Thorax, 2017; 72(6): 576–578. doi:10.1136/thoraxjnl-2016-209540
Panchal AR, Bartos JA, Cabañas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for CPR and ECC. Circulation, 142 (16_suppl_2), S366–S468, 2020. doi:10.1161/CIR.0000000000000916
Resuscitation Council UK (2021). Paediatric basic life support Guidelines. Online] https://www.resus.org.uk/library/2021-resuscitation-guidelines/paediatric-basic-life-support-guidelines [Accessed: 7th June 2025]
Resuscitation Council UK. Adult basic life support Guidelines. [Online] https://www.resus.org.uk/library/2021-resuscitation-guidelines/adult-basic-life-support-guidelines [Accessed: 8th June 2025]
Topjian AA, Raymond TT, Atkins DL, et al. Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16_suppl_2):S469–S523. doi:10.1161/CIR.0000000000000901
Dodson H, Sharma S, Cook J. Foreign Body Airway Obstruction. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Jan 2025. [Online] https://www.ncbi.nlm.nih.gov/books/NBK553186 [Accessed: 1st July 2025]
Chen Z, Zhu F, Zhang N, et al. Therapeutic experience from 1428 patients with pediatric tracheobronchial foreign body. Journal of Pediatric Surgery. 2008;43(4):718–721. doi:10.1016/j.jpedsurg.2007.10.010
Saki N, Nikakhlagh S, Rahim F, et al. Foreign body aspirations in infancy: a 20-year experience. International Journal of Medical Sciences. 2009;6(6):322–328. doi:10.7150/ijms.6.322
National Safety Council. Injury Facts: Deaths in the home and community by age group and cause. [Online] https://injuryfacts.nsc.org/home-and-community/home-and-community-overview/deaths-in-the-home-and-community-by-age-group-and-cause/ [Accessed: 10th June 2025]
Centers for Disease Control and Prevention (CDC). Web-based Injury Statistics Query and Reporting System (WISQARS): Leading Causes of Death Reports, 1981–2020. [Online] https://wisqars.cdc.gov/fatal-leading [Accessed: 10th June 2025]
Parvar SY, Sarasyabi MS, Moslehi MA, et al. The characteristics of foreign bodies aspirated by children across different continents: A comparative review. Pediatric Pulmonology. 2023;58(2):408–424. doi:10.1002/ppul.26242
Chang DT, Abdo K, Bhatt JM, et al. Persistence of choking injuries in children. International Journal of Pediatric Otorhinolaryngology. 2021;144:110685. doi:10.1016/j.ijporl.2021.110685
Centers for Disease Control and Prevention (CDC). Nonfatal choking-related episodes among children—United States, 2001. Morbidity and Mortality Weekly Report. 2002;51(42):945–948. [Online] https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5142a1.htm [Accessed: 10th June 2025]
Passàli D, Lauriello M, Bellussi L, et al. Foreign body inhalation in children: an update. Acta Otorhinolaryngol Italica, 30 (1), 27–32, 2010.
Foltran F, Ballali S, Passali FM, et al. Foreign bodies in the airways: a meta-analysis of published papers. International Journal of Pediatric Otorhinolaryngology, 76 (Suppl 1), S12–S19, 2012. https://doi.org/10.1016/j.ijporl.2012.02.004
Aslan N, Yıldızdaş D, Özden Ö, et al. Evaluation of foreign body aspiration cases in our pediatric intensive care unit: single-center experience. Turkish Archives of Pediatrics. 2019;54(1):44–48. doi: 10.14744/TurkPediatriArs.2019.60251
Tanrıverdi MH, Çelik C, et al. Bronkoskopik değerlendirme ile yabancı cisim aspirasyonu tanısının doğruluğu. Gaziosmanpaşa Tıp Dergisi, 7 (2), 60–65, 2015.- bu yok
Hemsley B, Steel J, Sheppard JJ, et al. Dying for a meal: an integrative review of characteristics of choking incidents and recommendations to prevent fatal and nonfatal choking across populations. American Journal of Speech-Language Pathology. 2019;28(3):1283–1297. doi:10.1044/2018_AJSLP-18-0150
Soma-Pillay P, Nelson-Piercy C, Tolppanen H, et al. Physiological changes in pregnancy. Cardiovascular Journal of Africa. 2016;27(2):89–94. doi:10.5830/CVJA-2016-021
LoMauro A, Aliverti A. Respiratory physiology of pregnancy. Breathe. 2015;11(4):297–301. doi:10.1183/20734735.008615
Rose DL. Airway foreign bodies. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. [Online] https://www.ncbi.nlm.nih.gov/books/NBK539756/ [Accessed: 14th June 2025]
Bajaj D, Sachdeva A, Deepak D. Foreign body aspiration. Journal of Thoracic Disease. 2021;13(8). doi:10.21037/jtd.2020.03.94
Ojeda Rodriguez J, Ladd M, Brandis D. Abdominal thrust maneuver. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. [Online] https://www.ncbi.nlm.nih.gov/books/NBK531467/ [Accessed: 9th June 2025]
Heimlich HJ. Pop goes the café coronary. Emergency Medicine. 1974;6:154–155.
Guildner CW, Williams D, Subitch T. Airway obstructed by foreign material: the Heimlich maneuver. Journal of the American College of Emergency Physicians. 1976;5(9):675–677. doi:10.1016/s0361-1124(76)80099-8
Sternbach G, Kiskaddon RT. Henry Heimlich: a life-saving maneuver for food choking. Journal of Emergency Medicine. 1985;3(2):143–148. doi:10.1016/0736-4679(85)90047-2
Heimlich HJ, Patrick EA. The Heimlich maneuver. Best technique for saving any choking victim's life. Postgraduate Medicine. 1990;87(6):38–48,53. doi:10.1080/00325481.1990.11716329
American Heart Association. Part 4: Adult basic life support. Circulation. 2005;112(24 Suppl). doi:10.1161/CIRCULATIONAHA.105.166553
Handley AJ, Koster R, Monsieurs K, et al. European Resuscitation Council guidelines for resuscitation 2005. Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation. 2005;67 Suppl 1: S7–S23. doi:10.1016/j.resuscitation.2005.10.007
American Heart Association. Heartsaver® Infant Choking Digital Poster: KJ-1708. Dallas (TX): American Heart Association; 2021.
American Red Cross. Adult and child choking. [Online] https://www.redcross.org/take-a-class/resources/learn-first-aid/adult-child-choking [Accessed: 9th June 2025]
Mayo Clinic Staff. First aid for choking: adult. [Online] https://www.mayoclinic.org/first-aid/first-aid-choking/basics/art-20056637 [Accessed: 9th June 2025]
Resuscitation Council UK. Adult choking algorithm. [Internet]. 2021. [Online] https://www.resus.org.uk/sites/default/files/2021-04/Adult%20Choking%20Algorithm%202021.pdf [Accessed: 14th June 2025]
Carlile T. Self-administered Heimlich maneuver. JAMA. 1983;249(23):3175. Doi:10.1001/jama.1983.03330470017017
European Resuscitation Council. European Resuscitation Council Guidelines 2021: Basic Life Support. [Online] https://cprguidelines.eu/assets/guidelines/European-Resuscitation-Council-Guidelines-2021-Ba.pdf [Accessed: 9th June 2025]
Visintine RE, Baick CH. Ruptured stomach after Heimlich maneuver. JAMA. 1975;234(4): 415.
Ebrahimi M, Mirhaghi A. Heimlich maneuver complications: a systematic review. Eurasian Journal of Emergency Medicine. 2019;18(3):157–165. doi: 10.4274/eajem.galenos.2019.21033.
Kleytman N, Satoskar S, Gonzalez CR, et al. Gastric rupture secondary to a Heimlich maneuver: a case report. Cureus. 2024;16(8):e66466. doi: 10.7759/cureus.66466.
Truong T, Salire K, De Cicco I, et al. Incarcerated diaphragmatic hernia following Heimlich maneuver. Proceedings (Baylor University Medical Center). 2017;31(1):48–50. Doi: 10.1080/08998280.2017.1391034.
Ulger H. Complications of the Heimlich maneuver: isolated sternum fracture. Journal of Clinical and Analytical Medicine. 2016;7(1):15–16.
Drinka P. Broken ribs following CPR or the Heimlich maneuver. Journal of the American Medical Directors Association. 2009;10(4):283–284. doi: 10.1016/j.jamda.2009.02.009.
Agia GA, Hurst DJ. Pneumomediastinum following the Heimlich maneuver. Journal of the American College of Emergency Physicians. 1979;8(11):473–475. Doi: 10.1016/s0361-1124(79)80064-7.
Koss SL, Karle WE, Dibelius G, et al. Esophageal perforation as a complication of the Heimlich maneuver in a pediatric patient: a case report. Ear, Nose & Throat Journal. 2018;97(7): E1–E3. Doi: 10.1177/014556131809700701.
Cecchetto G, Viel G, Cecchetto A, et al. Fatal splenic rupture following Heimlich maneuver: case report and literature review. American Journal of Forensic Medicine and Pathology. 2011;32(2):169–171. doi: 10.1097/PAF.0b013e318219c878.
Otero Palleiro MM, Barbagelata López C, Fernández Pretel MC, et al. Hepatic rupture after Heimlich maneuver. Annals of Emergency Medicine. 2007;49(6):825–826. Doi: 10.1016/j.annemergmed.2006.12.019
Valero V. Mesenteric laceration complicating a Heimlich maneuver. Annals of Emergency Medicine. 1986;15(1):105–106. Doi: 10.1016/s0196-0644(86)80536-4.
Wang C, Wang ZZ, Wang TB. Blunt myocardial injury and gastrointestinal hemorrhage following Heimlich maneuver: a case report and literature review. World Journal of Emergency Medicine. 2022;13(3):248–250. doi: 10.5847/wjem.j.1920 8642.2022.038
Lee KY, Wu YL, Ho SW. Silent aortic dissection after the Heimlich maneuver: a case report. Journal of Emergency Medicine. 2019;56(2):210–212. Doi: 10.1016/j.jemermed.2018.09.053.
Desai SC, Chute DJ, Desai BC, et al. Traumatic dissection and rupture of the abdominal aorta as a complication of the Heimlich maneuver. Journal of Vascular Surgery. 2008;48(5):1325–1327. Doi: 10.1016/j.jvs.2008.05.061.
Pawlukiewicz AJ, Merrill DR, Griffiths SA, et al. Cholesterol embolization and arterial occlusion from the Heimlich maneuver. American Journal of Emergency Medicine. 2021;43:290.e1–290.e3. doi: 10.1016/j.ajem.2020.09.079.
Putnam EM, Allen RL, Engle AJ, et al. Virtual reality simulation for critical pediatric airway management training. Journal of Clinical and Translational Research. 2021;7(1):93–99.
Shepherd W. Airway foreign bodies in adults. 2025. [Online]. Available: https://www.uptodate.com/contents/airway-foreign-bodies-in-adults?search=choking&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H3839937. [Accessed: 14 Haz 2025].
Limper AH, Prakash UB. Tracheobronchial foreign bodies in adults. Annals of Internal Medicine. 1990;112(8):604–609. doi: 10.7326/0003-4819-112-8-604.
Chen CH, Lai CL, Tsai TT, et al. Foreign body aspiration into the lower airway in Chinese adults. Chest. 1997;112(1):129–133. doi: 10.1378/chest.112.1.129.
Duan L, Chen X, Wang H, et al. Surgical treatment of late-diagnosed bronchial foreign body aspiration: a report of 23 cases. Clinical Respiratory Journal. 2014;8(3):269–273. doi: 10.1111/crj.12040.
Paludi MA, Palermo N, Limonti F, et al. A systematic review on suction-based airway clearance devices for foreign body airway obstruction. International Emergency Nursing. 2025;79:101575. doi: 10.1016/j.ienj.2025.101575.
Patterson E, Tang HT, Ji C, et al. The efficacy and usability of suction-based airway clearance devices for foreign body airway obstruction: a manikin randomised crossover trial. Resuscitation Plus. 2021;5:100067. doi: 10.1016/j.resplu.2020.100067.
Ramaswamy A, Done A, Solis R, et al. The efficacy of two commercially available devices for airway foreign body relief: a cadaver study. Laryngoscope Investigative Otolaryngology. 2023;8(3):708–711. doi: 10.1002/lio2.1057.
Dunne CL, Osman S, Viguers K, et al. Phase one of a global evaluation of suction-based airway clearance devices in foreign body airway obstructions: a retrospective descriptive analysis. International Journal of Environmental Research and Public Health. 2022;19(7):3846. doi: 10.3390/ijerph19073846.
Resuscitation Council UK. RCUK’s position on the use of suction-based airway clearance devices in choking individuals. Resuscitation Council UK. May 2023. [Çevrimiçi]. Available: https://www.resus.org.uk/about-us/news-and-events/rcuks-position-use-suction-based-airway-clearance-devices-choking-individuals. [Accessed: 14 Haz 2025].
