Foreign Body Airway Obstruction Research Articles

Popular websites as a source of misinformation on first aid in foreign body airway obstruction.

Popular websites as a source of misinformation on first aid in foreign body airway obstruction.

Systematic review shows that suction-based airway clearance devices for foreign body airway obstruction are promising.

Systematic review shows that suction-based airway clearance devices for foreign body airway obstruction are promising.

Foreign body airway obstruction resulting in out-of-hospital cardiac arrest in Denmark – Incidence, survival and interventions

BackgroundForeign body airway obstruction (FBAO) stands as an important contributor to accidental fatalities, yet prompt bystander interventions have been shown to improve survival. This study aimed to evaluate the incidence, interventions, and survival outcomes of patients with out-of-hospital cardiac arrest (OHCA) related to FBAO in comparison to patients with non-FBAO OHCA. MethodsIn this population-based cohort study, we included all OHCAs in Denmark from 2016 to 2022. Cases related to FBAO were identified and linked to the patient register. Descriptive and multivariable analyses were performed to evaluate prognostic factors potentially influencing survival. ResultsA total of 30,926 OHCA patients were included. The incidence rate of FBAO-related OHCA was 0.78 per 100,000 person-years. Among FBAO cases, 24% presented with return of spontaneous circulation upon arrival of the emergency medical services. The 30-day survival rate was higher in FBAO patients (30%) compared to non-FBAO patients (14%). Bystander interventions were recorded in 26% of FBAO cases. However, no statistically significant association between bystander interventions or EMS personnels’ use of Magill forceps and survival was shown, aOR 1.47 (95 % CI 0.6–3.6) and aOR 0.88 (95% CI 0.3–2.1). ConclusionFBAO-related OHCA was rare but has a higher initial survival rate than non-FBAO related OHCA, with a considerable proportion of patients achieving return of spontaneous circulation upon arrival of the emergency medical service personnel. No definitive associations were established between survival and specific interventions performed by bystanders or EMS personnel. These findings highlight the need for further research in this area.

A 2-year prospective evaluation of airway clearance devices in foreign body airway obstructions

AimTo collect, analyze and report the first prospective, industry-independent, data on airway clearance devices as novel foreign body airway obstruction interventions. MethodsWe recruited adult airway clearance device users between July 1, 2021 and June 30, 2023 using a centralized website and email follow-up. The data collection tool captured patient, responder, situation, and outcome variables. Multi-step respondent validation occurred using electronic and geolocation verification, a random selection follow-up process, and physician review of all submitted cases. ResultsWe recruited 186 airway clearance device users (LifeVac©:157 [84.4%]; Dechoker©:29 [15.6%]). LifeVac© was the last intervention before foreign body airway obstruction relief in 151 of 157 cases. Of these, 150 survived to discharge. A basic life support intervention was used before LifeVac© in 119 cases, including the 6 cases where LifeVac© also failed. We identified two adverse events using LifeVac© (perioral bruising), while we could not ascertain whether another 7 were due to the foreign body or LifeVac© (3 = airway edema; 3 = oropharyngeal abrasions; 1 = esophageal perforation). Dechoker© was the last intervention before obstruction relief in 27 of 29 cases and all cases survived. A basic life support intervention was used before Dechoker© in 21 cases, including both where Dechoker© also failed. We identified one adverse event using Dechoker© (oropharyngeal abrasions). ConclusionWithin these cases, airway clearance devices appear to be effective at relieving foreign body airway obstructions. However, this data should be considered preliminary and hypothesis generating due to several limitations. We urge the resuscitation community to proactively evaluate airway clearance devices to ensure the public remains updated with best practices.

314 A Comparison between 2 teaching strategies for schoolchildren to save foreign body airway obstruction

314 A Comparison between 2 teaching strategies for schoolchildren to save foreign body airway obstruction

Risk factors and prevention of choking.

Choking (or foreign body airway obstruction) is a widespread phenomenon with serious consequences of morbidity and mortality. Choking (often also called suffocation) can be caused by food or inedible objects and leads to various degrees of asphyxiation or lack of oxygen in the blood stream. The incidence is very high in both young children and adults, especially seniors. However, since not all choking episodes end up in the emergency room or become fatalities, they often escape statistics. Although episodes of choking from non-edible bodies are infrequent, they affect mostly young children. Three of the most common risks for choking in general are neurological disorders, dysphagia and dental issues (few or no teeth, unstable or unsuitable prosthesis or orthodontic appliances). The purpose of this study was to evaluate the risk factors of choking and ways to reduce/avoid this event. We reported data on a series of 138 patients admitted to the emergency department following a choking event, at a hospital in Rome, Italy. The age group of the analyzed population ranged from 1 to 88 years, with the most represented age group of these between 40 and 59, with a similar distribution between males and females. The types of foods on which people choked reflected the seasonal, traditional and local foods: 67% of patients reported choking on fish bones followed by meat bones (9%) and artichokes (3%). Three relevant non-food choking elements reported were: orthodontic items, toothpicks and pins (one occurrence each). We also reported on two clinical cases of patients choking on meat and a chicken bone. In conclusion, choking awareness and prevention are essential for implementing potential life-saving precautions. Prevention is the first tool to reduce the occurrence of this event, therefore it is necessary to analyze the risk factors and educate the population to eliminate them. Proper chewing and oral manipulation are paramount functions in preventing choking, along with meal-time supervision if little children and elderly. Then, it behooves the healthcare professionals to disseminate knowledge.

Pseudo-pulseless electrical activity in foreign body airway obstruction

Pseudo-pulseless electrical activity in foreign body airway obstruction

School children brief training to save foreign body airway obstruction

Foreign body airway obstruction (FBAO) is a relatively common emergency and a potential cause of sudden death both in children and older people; bystander immediate action will determine the victim’s outcome. Although many school children’s basic life support (BLS) training programs have been implemented in recent years, references to specific training on FBAO are lacking. Therefore, the aim was to assess FBAO-solving knowledge acquisition in 10–13-year-old school children. A quasi-experimental non-controlled simulation study was carried out on 564 ten-to-thirteen-year-old children from 5 schools in Galicia (Spain). Participants received a 60-min training led by their physical education teachers (5 min theory, 15 min demonstration by the teacher, and 30 min hands-on training) on how to help to solve an FBAO event. After the training session, the school children’s skills were assessed in a standardized adult’s progressive FBAO simulation scenario. The assessment was carried out by proficient researchers utilizing a comprehensive checklist specifically designed to address the variables involved in resolving a FBAO event according with current international guidelines. The assessment of school children’s acquired knowledge during the simulated mild FBAO revealed that 62.2% of participants successfully identified the event and promptly encouraged the simulated patient to cough actively. When the obstruction progressed, its severity was recognized by 86.2% and back blows were administered, followed by abdominal thrusts by 90.4%. When the simulated victim became unconscious, 77.1% of children identified the situation and immediately called the emergency medical service and 81.1% initiated chest compressions. No significant differences in performance were detected according to participants’ age. Conclusion: A brief focused training contributes to prepare 10–13-year-old school children to perform the recommended FBAO steps in a standardized simulated patient. We consider that FBAO should be included in BLS training programs for school children.What is Known:• Kids Save Lives strategy states that school children should learn basic life support (BLS) skills because of their potential role as first responders.• This BLS training does not include content for resolving a foreign body airway obstruction (FBAO).What is New:• Following a 60-min theoretical-practical training led by physical education teachers, 10–13-year-old school children are able to solve a simulated FBAO situation.• The inclusion of FBAO content in BLS training in schools should be considered.

Foreign Body Airway Obstruction: Modern Principles and Approaches to First Aid and Dispatcher Assistance on First Aid

Foreign body airway obstruction (FBAO) is one of the most common causes of accidental death in adults and children. Probability of saving a life in severe FBAO depends on the ability of the bystander to quickly recognize the problem and correctly provide first aid (FA) to the victim. However, due to the lack of knowledge and skills of the FA, bystanders rarely attempt to give necessary help. Along with mass FA training, provision of instructions on the FA to untrained bystanders over the telephone by emergency medical services (EMS) dispatchers can facilitate active involvement of the population in the process of providing FA. In this study, a detailed analysis of the modern principles and approaches to the provision of the FA in FBAO was carried out and a draft of a universal Russian-language algorithm for remote dispatch support of the FA was developed. The developed algorithm can become a component of the domestic program for remotely instructing the population on provision of FA in life-threatening conditions and is proposed for further testing and implementation in the practice of EMS dispatchers.

An Evaluation of Nurse Anesthetists’ Acquisition and Retention of Knowledge and Skill Performance for Brief Basic Life Support and Advanced Cardiac Life Support Training

OBJECTIVE The purpose of this study was to evaluate the acquisition and retention of knowledge and skills of basic (BLS) and advanced cardiac life support (ACLS) for nurse anesthetists at Maharaj Nakorn Chiang Mai Hospital. METHODS The one-group pretest-posttest design study was used. BLS and ACLS training comprised a brief BLS and ACLS review and practice. Knowledge was assessed by multiple-choice questions. The BLS skills were assessed by observing CPR performance on a Resusci- Anne-skill meter manikin and ACLS skills were evaluated using ACLS scenarios. The knowledge and skills were assessed before and after the training weekly for four weeks, and then at three months after the training ended. RESULTS A total of 38 nurse anesthetists participated in the study. There were significant increases in BLS and ACLS knowledge and skills after the training. However, there was short retention of BLS and ACLS knowledge and skills at three months after the training. Foreign body airway obstruction and assessing unresponsiveness were the two most common of BLS skills degradation. While the primary and secondary assessment, assessing ACLS algorithms, electrocardiogram recognition and electrical therapy were the common skills performance of ACLS skills degradation. CONCLUSIONS After the BLS and ACLS training, the knowledge and skills were significantly improved but there was short retention of knowledge and skills at three months after the training. Regular refreshment of CPR education is recommended to enhance the retention of knowledge and practice of nurse anesthetists KEYWORDS knowledge and skills retention, nurse anesthetists, acquisition, basic life support, advanced cardiac life support

Would anti-choking devices be correctly and quickly managed by health science students? A manikin crossover trial

BackgroundThe brand-new anti-choking devices (LifeVac® and DeCHOKER®) have been recently developed to treat Foreign Body Airway Obstruction (FBAO). However, the scientific evidence around these devices that are available to the public is limited. Therefore, this study aimed to assess the ability to use the LifeVac® and DeCHOKER® devices in an adult FBAO simulated scenario, by untrained health science students.MethodsForty-three health science students were asked to solve an FBAO event in three simulated scenarios: 1) using the LifeVac®, 2) using the DeCHOKER®, and 3) following the recommendations of the current FBAO protocol. A simulation-based assessment was used to analyze the correct compliance rate in the three scenarios based on the correct execution of the required steps, and the time it took to complete each one.ResultsParticipants achieved correct compliance rates between 80–100%, similar in both devices (p = 0.192). Overall test times were significantly shorter with LifeVac® than DeCHOKER® device (36.6 sec. [31.9–44.4] vs. 50.4 s [36.7–66.9], p < 0.001). Regarding the recommended protocol, a 50% correct compliance rate was obtained in those with prior training vs. 31.3% without training, (p = 0.002).ConclusionsUntrained health science students are able to quickly and adequately use the brand-new anti-choking devices but have more difficulties in applying the current recommended FBAO protocol.

Characteristics and Outcomes of Emergency Transferred Patients with Foreign Body Airway Obstruction in Tokyo, Japan.

Foreign body airway obstruction (FBAO) is a life-threatening emergency, and the prognosis of patients with FBAO is greatly affected by the prehospital process. There are only a few large-scale studies analyzing prehospital process databases of the fire department. The aim of this study was to investigate whether characteristics of patients with FBAO were associated with prehospital factors and outcomes. In this retrospective observational study, patients transferred to the hospital by the Tokyo, Japan Fire Department for FBAO from 2017 through 2019 were included. The association between neurologically favorable survival among the characteristics of patients with FBAO and prehospital factors affecting the outcomes was evaluated. Of the 2,429,175 patients, 3,807 (0.2%) patients had FBAO. The highest number of FBAO cases was 99 (2.6%), which occurred on January 1 (New Year's Day), followed by 40 cases (1.1%) on January 2, and 28 cases (0.7%) on January 3. The number of patients who experienced out-of-hospital cardiac arrest (OHCA) caused by FBAO was 1,644 (43.2%). Comparing the OHCA and non-OHCA groups, there were significant differences in age, sex, time spent at the site, and distance between the site and hospital. Cardiac arrest was significantly lower in infants after FBAO (P < .001). In total, 98.2% of patients who did not have return of spontaneous circulation (ROSC) before hospital arrival died within 30 days, a significantly higher mortality rate than that in patients who had ROSC (98.2% versus 65.8%; P < .001). Among patients who did not have ROSC following FBAO upon arrival at the hospital, 98.2% died within 30 days. Thus, it is important to remove foreign bodies promptly and provide sufficient ventilation to the patient at the scene to increase the potential for ROSC. Further, more precautions should be exercised to prevent FBAO at the beginning of the year.

Acute lethargy, stridor, and hypoxemia in a young adult.

A young adult with intellectual delay presented to the emergency department (ED) from a group home via ambulance with altered mental status and respiratory distress. The patient was known to be non-verbal but definitely alert and interactive at baseline. On arrival, the patient was lethargic with frequent coughing and notable stridor, unable to obey commands. Emergency medical services reported SpO2 was initially 85%, but the hypoxemia had improved with supplemental oxygen administered via non-rebreather mask. Partial airway obstruction was suspected due to the stridor, and it was feared that the paralysis of rapid sequence intubation might result in a “can't oxygenate, can't ventilate” scenario. Preparations were made for immediate emergency airway management with a dual set-up for awake fiberoptic tracheal intubation and a cricothyroidotomy. Nasal cannula was applied at flush rate with SpO2 sustained at 100% throughout the procedure. Ketamine was used to facilitate fiberoptic nasopharyngoscopy, which identified a green foreign body obstructing a view of the entire glottis. Standard geometry video laryngoscopy was then employed to guide foreign body retrieval with Magill forceps and a DuCanto (SSCOR, Inc) suction catheter (Video 1). It was evident during removal that the foreign body was aspirated broccoli. The patient recovered from sedation and had no further need for supplemental oxygen in the ED. The patient was treated for aspiration pneumonia, admitted for observation, and was discharged at their neurologic baseline the next day. Incomplete foreign body airway obstruction (FBAO) is a time-sensitive emergency that mandates urgent intervention before progression to complete obstruction, which will always rapidly deteriorate to cardiac arrest. Immediate removal is critical to patients surviving with good neurologic outcomes in the event of a cardiac arrest.1 Operators should be prepared to follow well-established algorithms for the management of incomplete and complete FBAOs.2 Magill forceps have been part of airway management for over a century3 and are known to be effective in removing FBAOs in prehospital cardiac arrests.4 The DuCanto (SSCOR, Inc) suction catheter is a wide-bore rigid suction catheter that has been shown to effectively remove viscous liquid in simulated airway contaminations5 but was successful in removing smaller solid foreign bodies for this case. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Contributions of telesimulation to the knowledge of mothers about foreign body airway obstruction.

To analyze the contributions of telesimulation to the knowledge of mothers faced with foreign body airway obstruction in children under 1 year of age and identify the related factors. A quasi-experimental study of the pre- and post-test design carried out between April and September 2021 with 49 mothers from a city in São Paulo. It was organized into four stages: pre-test, telesimulation, immediate and late post-test (60 days later). All steps were carried out remotely via the free online platform Google Hangouts® and Google Forms®. Data analyzed by descriptive and analytical statistics. There was a significant difference in the knowledge score between the assessments (p<0.001). Statistically significant relationships were identified between pre-test knowledge and choking experience (p=0.012), promotion of immediate knowledge and another child's choking (p=0.040) and schooling (p=0.006) and promotion of late knowledge with occupation (p=0.012) and choking of another child (p=0.011). There was a significant improvement in knowledge after telesimulation, especially among those who had never experienced a choking situation and had a higher level of education.

Contributions of telesimulation to the knowledge of mothers about foreign body airway obstruction

RESUMO Objetivo: Analisar as contribuições da telessimulação no conhecimento de mães diante situação de obstrução de vias aéreas por corpo estranho em crianças menores de um ano e identificar os fatores relacionados. Métodos: Estudo quase experimental do tipo pré e pós-teste realizado entre abril e setembro de 2021 com 49 mães de um município paulista. Foi organizado em quatro etapas: pré-teste, telessimulação, pós-teste imediato e tardio (60 dias após). Todas as etapas foram conduzidas remotamente via plataforma on-line de acesso livre Google Hangouts® e Google Forms®. Os dados foram analisados por estatística descritiva e analítica. Resultados: Houve diferença significativa na pontuação de conhecimento entre as avaliações (p&lt;0,001). Foram identificadas relações estatisticamente significativas entre conhecimento pré-teste e experiência de engasgo (p=0,012), promoção do conhecimento imediato com engasgo de outra criança (p=0,040) e escolaridade (p=0,006) e promoção do conhecimento tardio com ocupação (p=0,012) e engasgo de outra criança (p=0,011). Conclusões: Houve melhora significativa no conhecimento após telessimulação, especialmente entre aquelas que nunca vivenciaram situação de engasgo e com maior escolaridade.

Development and Application of AR-Based Assessment System for Infant Airway Obstruction First Aid Training.

Airway obstruction refers to suffocation caused by blockage of the airway due to a foreign body and is a common cause of accidental death in infants below one year of age. However, the current infant CPR manikins used for training in first aid for foreign body airway obstruction can only be applied to one single scenario. Furthermore, trainees' first aid skills cannot be recorded and quantified with a digital system and, consequently, assessment of their skills is difficult to conduct. This study aims to overcome the technical limitations by developing an AR-based assessment system for training in first aid for infant airway obstruction. With this assessment system, trainees can learn first aid more efficiently and correctly and conduct a quantitative assessment of their skills digitally. For instructors, the time required for assessment, potential human error, and the cost of training can also be reduced. The system can be a practical learning tool that helps trainees assess emergencies and integrate their knowledge and skills.

Emergency physician-performed emergency bronchoscopy in cardiac arrest patient due to acute foreign body airway obstruction.

As foreign body airway obstruction (FBAO) can be life-threatening, it has to be promptly diagnosed and treated. We report a case series of three patients presenting to the emergency department with cardiac arrest due to FBAO. In each case, ventilation was difficult due to high airway resistance. As FBAO was suspected, the emergency physician did a prompt flexible bronchoscopy to confirm the diagnosis and retrieve the foreign body. Flexible bronchoscopy is an important diagnostic and therapeutic tool for emergency airway management, and is a relatively safe procedure if performed by a trained personnel. The life-saving benefits of bronchoscopy outweigh the small risks of complications such as bleeding, desaturation and pneumothorax. In the three cases, the removal of the obstructing material led to immediate improvements in oxygenation and ventilation. The patients had return of spontaneous circulation after cardiopulmonary resuscitation and definite airway control.

Airway obstruction time and outcomes in patients with foreign body airway obstruction: multicenter observational choking investigation

AimForeign body airway obstruction (FBAO) is a major public health concern worldwide for infants and older adults. This study determines the association between airway obstruction time and neurological outcomes to plan an effective response for patients with FBAO.MethodsThis multicenter retrospective observational study was carried out among patients with life‐threatening FBAO in Japan over a period of 4 years. The duration of airway obstruction was calculated from the time of the accident to the time of foreign body removal. The study examined the relationship between airway obstruction time and outcome. The primary outcome was vegetative state or death at hospital discharge.ResultsAmong 119 patients, 68 were in the category of vegetative state or death. Logistic regression analysis showed that longer airway obstruction time (adjusted odds ratio 1.04; 95% confidence interval 1.01–1.07) was associated with vegetative state or death. When the cut‐off value was set at 10, the sensitivity was 0.88, the specificity 0.47, with the area under the curve 0.69. Using the other cut‐off value of 4 min, the negative predictive value was 1.00.ConclusionLonger airway obstruction time was associated with vegetative state or death for patients with FBAO. The incidence of vegetative state or death increased when the airway obstruction time exceeded 10 min. Meanwhile, 4 min or less may be set as a target time for foreign body removal in order to prevent vegetative state or death and plan an effective response.

Basic life support

Der Europäische Rat für Wiederbelebung hat diese Leitlinie – Basismaßnahmen zur Wiederbelebung – auf Grundlage des International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations 2020 erstellt. Die behandelten Themen umfassen: Erkennen eines Herz-Kreislauf-Stillstands, Alarmierung des Rettungsdiensts, Herzdruckmassage (Thoraxkompressionen), Beatmung/Atemspende, automatisierte externe Defibrillation (AED), Qualitätsmessung der Wiederbelebung, neue Technologien, Sicherheit und Verlegung der Atemwege durch Fremdkörper.

Neurological outcomes associated with prehospital advanced airway management in patients with out-of-hospital cardiac arrest due to foreign body airway obstruction

ObjectivesSeveral studies have examined the association between advanced airway management (AAM) and survival for arrest that is non-shockable, noncardiac in origin, or due to suffocation; however, the efficacy of prehospital AAM compared with no AAM following foreign body removal by emergency medical services (EMS) has not been examined. We aimed to compare neurological outcomes in patients after out-of-hospital cardiac arrest (OHCA) due to foreign body airway obstruction (FBAO) managed with and without AAM after foreign body removal. MethodsThis retrospective observational cohort study used all emergency transportation data of Japan and the All-Japan Utstein Registry. We included patients with OHCA aged ≥18 years undergoing resuscitation and removal of airway foreign bodies by EMS from January 2015 to December 2017. The exposure of interest was prehospital AAM by EMS after foreign body removal, and the primary outcome was a favorable neurological outcome at hospital discharge (i.e., a cerebral performance category of 1–2). ResultsOverall, 329,098 adults had OHCAs and 23,060 had foreign bodies removed from their airways; 3681 adult patients met our eligibility criteria and were divided as: AAM (2045) and non-AAM (1636) groups. Propensity score matching resulted in 1210 matched pairs with balanced baseline characteristics between the groups. The rate of favorable neurological outcome was significantly lower in the AAM group than in the non-AAM group (OR 0.34, 95% CI 0.19–0.62). However, survival was not significantly different between the two groups (OR 1.08, 95% CI 0.84–1.37). ConclusionsWe have not demonstrated the benefit of AAM for patients with OHCA due to FBAO. Further study will be required to confirm the efficacy of AAM for those patients.