Drowning, as defined by the World Health Organization, is the process of experiencing respiratory impairment due to submersion or immersion in liquid. Despite global efforts to prevent drowning, it remains the primary driver of deaths for children under 5 in the United States, and the third leading cause of accidental death worldwide, disproportionately affecting rural and low-to-middle-income areas [1-4].
Drowning outcomes range from mild respiratory impairment to severe neurological damage and death, known as fatal drowning. Immediate bystander intervention is essential in these cases, yet data on pre-hospital interventions are scarce. In 2-10% of drowning cases, laryngospasm occurs; a protective reflex in which the body forcibly closes the airways to prevent aspirate from entering the lungs [5]. While the primary injury from drowning is due to hypoxia, the extent to which laryngospasms contribute to this remains understudied, with limited literature on physiology or effective interventions [6,7].
One leading question from this case is whether there are clinical benefits of manual gastric decompression, also known as the Heimlich maneuver, during cardiopulmonary resuscitation (CPR) in a drowned victim with laryngospasms. This hypothesis was peripherally raised by Dr. Heimlich, who collected cases of drowning victims benefitting from the Heimlich maneuver. His theory that it cleared aspirate from the lungs was invalidated; however, this case proposes an alternative explanation. The Heimlich maneuver may benefit certain drowning victims by ejecting fluid and vomitus from the stomach, and decompressing the gastric space. In gastric distention, elevated abdominal pressure can impair ventilation and cardiac output by restricting lung expansion and decreasing venous return and cardiac output. Thus, safely decompressing the stomach may allow the vagus nerve to signal the superior laryngeal nerve to clear the laryngospasm and improve ventilation [5,7]. In emergencies where airway and perfusion are priorities, this approach could be lifesaving, especially when the risk of decompression aspiration is minimal by the completely closed airway in cases of laryngospasm [8].
In an emergency where optimal intervention focuses on airway and perfusion, could safely decompressing the stomach by inducing vomitus save lives? This case study aims to contribute to the ongoing discussion and research on this critical issue, which has profound social implications for families and communities.