Abstract 86: Existing Research Is Inadequate for the Development of Guidelines for the Basic Life Support Management of Airway Obstruction in Adults: Results of a Systematic Review

Abstract

Introduction: There has been considerable controversy and several changes in guidelines for the basic life support (BLS) management of choking since the introduction of the Heimlich procedure in 1974. Hypothesis: The objective of this project was to conduct a structured literature review to answer the question, “For adults, either conscious or unconscious, with obstructed airway, does any specific resuscitation techniques compared to currently recommended techniques, lead to different outcomes?” Methods: We searched MEDLINE using a complex search criterion. We performed further searches on the basis of articles cited in references and by using the ‘Cited by’ function in Google Scholar. We included articles if they addressed a therapy for choking in adults. We excluded articles if they addressed only pediatric patients, if there was no comparison group, or if the skills involved were beyond BLS. We collected data using a standardized study selection and data extraction form. This included specific criteria to grade the level of evidence (LOE) and quality of each paper. Results: We identified 475 records after duplicates were removed; we screened all of these and excluded 454. This left 22 full-text articles which we assessed for eligibility; we excluded 19 of these, leaving 3 studies that we included in qualitative synthesis. Of these, data from one fair quality LOE 3b study suggests that peak airway pressures developed by chest compressions are significantly higher than the pressure from abdominal thrusts. Data from one poor quality LOE 4 study suggests that for conscious adults with an obstructed airway, abdominal thrusts generate higher peak airway pressures when delivered when the victim is supine as compared to seated and that back blows do not generate any significant change in airway pressure. We could not identify any other papers that compared BLS techniques for managing obstructed airways in adults. Clearly, there is a dearth of evidence to support basic life support treatment guidelines for this important problem. Conclusions: In conclusion, rescuers attempting to resolve a complete airway obstruction in a conscious or unconscious adult should provide abdominal thrusts or chest compressions.