Dangers of the Heimlich Maneuver for Esophageal Obstruction

To the Editor: In a letter entitled “Heimlich Maneuver for Esophageal Obstruction” (April 13 issue),¹ Dr. Nelson described his successful use of the Heimlich maneuver in treating a high-esophageal obstruction caused by a hard candy his daughter had swallowed. I do not think that this practice can be safely recommended for the treatment of esophageal obstruction. This maneuver is associated with complications that include vomiting and aspiration,² perforation of the esophagus, stomach, or jejunum,^{3 4 5} cardiac and great-vessel trauma,^6,7 and herniation of the diaphragm⁸ and of the pneumomediastinum.⁹ The dangers are illustrated by the case of a woman who had esophageal.