The Heimlich maneuver as an aid in endotracheal intubation of neonates

Neonates with acute respiratory failure and certain other clinical conditions may require emergency endotracheal intubation. During the procedure, one periodically encounters laryngospasm with the vocal cords tightly apposed to each other, resisting passage of the endotracheal tube. The authors have encountered four such neonates during the past 12 months. Two neonates suffered from severe birth asphyxia and required intubation in the delivery room. A third infant was intubated because of progressive hypoxemia and hypercarbia secondary to hyaline membrane disease, and the fourth was intubated for an elective surgical procedure. A brief period of forced expiration produced by a depression of the sternum, a modification of the Heimlich maneuver, opened the vocal cords, enabling a smooth, relatively atraumatic intubation in all four infants.