A ‘foreign body’ in the ‘foreign body airway obstruction’ algorithm

Abstract

Foreign body airway obstruction [FBAO] causes thousands of deaths yearly, particularly in vulnerable populations who have difficulty protecting their airway, such as the elderly or children. 1 WHO. WHO Mortality Database. WHO n.d. (accessed 1 March 2020, at https://www.who.int/healthinfo/mortality_data/en/). Google Scholar , 2 Sethi D. World Health Organization European report on child injury prevention. World Health Organization Europe, Copenhagen2008 Google Scholar , 3 Cheng J. Liu B. Farjat A.E. Routh J. National estimations of airway foreign bodies in children in the United States, 2000 to 2009. Clin Otolaryngol. 2018; https://doi.org/10.1111/coa.13261 Crossref Scopus (7) Google Scholar Rapid bystander interventions can significantly improve survival. Specific manoeuvres, tailored to the age of the victim, have been part of consecutive resuscitation guidelines for more than 25 years. 4 Igarashi Y. Yokobori S. Yoshino Y. Masuno T. Miyauchi M. Yokota H. Prehospital removal improves neurological outcomes in elderly patient with foreign body airway obstruction. Am J Emerg Med. 2017; 35: 1396-1399https://doi.org/10.1016/j.ajem.2017.04.016 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar , 5 Maconochie I.K. Bingham R. Eich C. et al. European resuscitation council guidelines for resuscitation 2015: section 6. Paediatric life support. Resuscitation. 2015; 95: 223-248https://doi.org/10.1016/j.resuscitation.2015.07.028 Abstract Full Text Full Text PDF PubMed Scopus (265) Google Scholar However, despite FBAO being an important health problem, and many anecdotal reports of successful airway clearance, the evidence supporting these guidelines is of very low certainty and sometimes conflicting. 6 Redding J.S. The choking controversy: critique of evidence on the Heimlich maneuver. Crit Care Med. 1979; 7: 475-479 Crossref PubMed Scopus (71) Google Scholar , 7 Langhelle A. Sunde K. Wik L. Steen P.A. Airway pressure with chest compressions versus Heimlich manoeuvre in recently dead adults with complete airway obstruction. Resuscitation. 2000; 44: 105-108 Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar , 8 Chillag S. Krieg J. Bhargava R. The Heimlich maneuver: breaking down the complications. South Med J. 2010; 103: 147-150https://doi.org/10.1097/SMJ.0b013e3181c99140 Crossref PubMed Scopus (12) Google Scholar , 9 Pavitt M.J. Swanton L.L. 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: 576-578https://doi.org/10.1136/thoraxjnl-2016-209540 Crossref PubMed Scopus (6) Google Scholar , 10 Heimlich H.J. Patrick E.A. The Heimlich maneuver. Best technique for saving any choking victim’s life. Postgrad Med. 1990; 87 (53): 38-48 Crossref PubMed Google Scholar Recently, two devices 11 LifeVac. Save a Life in a Choking Emergency. LifeVac n.d. (accessed 1 March 2020, at https://lifevac.net/). Google Scholar , 12 Dechoker. Dechoker - Choking First-Aid FDA Class I Medical Device. Dechoker n.d. (accessed 1 March 2020, at https://www.dechoker.com/). Google Scholar have become extensively commercialized as anti-choking devices. Both are non-powered portable suction devices, described by their manufacturers as easy to use, and safe and effective for all ages above 1 year of age. A mask is used to create a seal and then a strong negative pressure is generated by a plunger-type system to dislodge the foreign body and thus reopen the obstructed airway. One of them also has an oropharyngeal component similar to an oropharyngeal airway that needs to be positioned above the tongue and it is marketed as a clear replacement of the existing international guidelines. Both devices are Class 1 FDA registered as ‘suction apparatus’. Such a simple registration is possible for low-risk devices. They are exempt from further FDA clearance (510 (k)) or formal approval and have not gone through a submission and evaluation process.