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Ranjous Y, Al Balkhi A, Alnader I, Rkab M, Ataya J, Abouharb R. Knowledge and misconceptions of choking and first-aid procedures among Syrian adults: A cross-sectional study. SAGE Open Med 2024; 12:20503121241249399. [PMID: 38725922 PMCID: PMC11080803 DOI: 10.1177/20503121241249399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
Background Choking is a critical emergency that occurs when foreign objects obstruct the airways. It commonly affects young children, older people, individuals with developmental disabilities, those with acquired or lifelong disability, and those with mental health conditions. Symptoms can vary, ranging from coughing to cyanosis. Aim Our study aims to evaluate Syrian adults' knowledge of choking and their understanding of first-aid procedures. Specifically, we will assess the prevalence of misconceptions in order to train community members and increase their level of knowledge about first aid for choking. Ultimately, our goal is to reduce deaths resulting from this critical condition. Methods This cross-sectional study aims to assess the knowledge and attitudes regarding choking among adults in Syria. The targeted population consists of Syrians aged between 18 and 45 years who reside in Syria. Data were collected through an online survey, disseminated via social media platforms from March to July 2022. Scores were computed to quantify levels of knowledge, with participants achieving a score of 16 or higher classified as having a high level of knowledge. The collected data were analyzed using descriptive statistics, Pearson's correlation coefficient, and chi-square tests. Results A total of 406 responded to the survey, with 246 (60.6%) scoring less than 16 points, indicating a low level of knowledge. Gender and place of residency were not correlated with knowledge level p = 0.249, p = 0.913, respectively). Participants employed in the medical field, those who had received training in first aid, and individuals with higher levels of education exhibited higher levels of knowledge. However, the level of knowledge was below expectations for these groups. Conclusion There should be an increase in the availability of first-aid courses to the public and improvements in hands-on training for physicians and medical trainees.
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Affiliation(s)
- Yahia Ranjous
- Faculty of Medicine, Damascus University, Damascus, Syria
| | | | | | - Majd Rkab
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Jamal Ataya
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Raed Abouharb
- Faculty of Medicine, Damascus University, Damascus, Syria
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Wolthers SA, Holgersen MG, Jensen JT, Andersen MP, Blomberg SNF, Mikkelsen S, Christensen HC, Jensen TW. Foreign body airway obstruction resulting in out-of-hospital cardiac arrest in Denmark - Incidence, survival and interventions. Resuscitation 2024; 198:110171. [PMID: 38461889 DOI: 10.1016/j.resuscitation.2024.110171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Foreign 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. METHODS In 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. RESULTS A 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). CONCLUSION FBAO-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.
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Affiliation(s)
- Signe Amalie Wolthers
- Emergency Medical Services, Prehospital Center, Region Zealand, Næstved, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Mathias Geldermann Holgersen
- Emergency Medical Services, Prehospital Center, Region Zealand, Næstved, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Søren Mikkelsen
- Prehospital Research Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, Denmark
| | | | - Theo Walther Jensen
- Emergency Medical Services, Prehospital Center, Region Zealand, Næstved, Denmark
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Katabami K, Kimura T, Hirata T, Tamakoshi A. Association Between Advanced Airway Management With Adrenaline Injection and Prognosis in Adult Patients With Asystole Asphyxia Out-of-hospital Cardiac Arrest. J Epidemiol 2024; 34:31-37. [PMID: 36709978 PMCID: PMC10701249 DOI: 10.2188/jea.je20220240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/26/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The neurological prognosis of asphyxia is poor and the effect of advanced airway management (AAM) in the prehospital setting remains unclear. This study aimed to evaluate the association between AAM with adrenaline injection and prognosis in adult patients with asystole asphyxia out-of-hospital cardiac arrest (OHCA). METHODS This study assessed all-Japan Utstein cohort registry data between January 1, 2013 and December 31, 2019. We used propensity score matching analyses before logistic regression analysis to evaluate the effect of AAM on favorable neurological outcome. RESULTS There were 879,057 OHCA cases, including 70,299 cases of asphyxia OHCAs. We extracted the data of 13,642 cases provided with adrenaline injection by emergency medical service. We divided 7,945 asphyxia OHCA cases in asystole into 5,592 and 2,353 with and without AAM, respectively. After 1:1 propensity score matching, 2,338 asphyxia OHCA cases with AAM were matched with 2,338 cases without AAM. Favorable neurological outcome was not significantly different between the AAM and no AAM groups (adjusted odds ratio [OR] 1.1; 95% confidence interval [CI], 0.5-2.5). However, the return of spontaneous circulation (ROSC) (adjusted OR 1.7; 95% CI, 1.5-1.9) and 1-month survival (adjusted OR 1.5; 95% CI, 1.1-1.9) were improved in the AAM group. CONCLUSION AAM with adrenaline injection for patients with asphyxia OHCA in asystole was associated with improved ROSC and 1-month survival rate but showed no differences in neurologically favorable outcome. Further prospective studies may comprehensively evaluate the effect of AAM for patients with asphyxia.
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Affiliation(s)
- Kenichi Katabami
- Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takashi Kimura
- Department of Public Health, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Takumi Hirata
- Department of Public Health, Hokkaido University Faculty of Medicine, Sapporo, Japan
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Nara, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Faculty of Medicine, Sapporo, Japan
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Suga R, Igarashi Y, Kitano S, Suzuki K, Yokobori S, Ogawa S, Yokota H. Effectiveness of the Abdominal Thrust Maneuver for Airway Obstruction Removal: Analysis of Data from the National Emergency Medical Services Information System. J NIPPON MED SCH 2024; 91:270-276. [PMID: 38972739 DOI: 10.1272/jnms.jnms.2024_91-305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
BACKGROUND Foreign body airway obstruction (FBAO) is a life-threatening emergency. Abdominal thrusts are recommended as first aid, but the success rate for this technique is unclear. Using information from a large database of emergency medical services (EMS) data in the United States, we evaluated the success rate of abdominal thrusts and identified patient characteristics that were associated with the success of the technique. METHODS A retrospective observational study was conducted using data from the National Emergency Medical Services Information System (NEMSIS) to ascertain the success of abdominal thrusts in patients with FBAO from nearly 14,000 EMS agencies. Success was defined by positive evaluations on subjective and objective EMS criteria. RESULTS Analysis of 1,947 cases yielded a 46.6% success rate for abdominal thrusts in removing obstructions. The age distribution was bimodal, with peaks during infancy and old age. June had the highest incidence of FBAO. Incidents were most frequent during lunch and dinner times, and most cases occurred in private residences. The first-time success rate was 41.5%, and a lower level of impaired consciousness was associated with lower success rates. A lower incidence of cardiac arrest was noted in successful cases. The success rate was high (60.2%) for children (age ≤15 years), with differences in demographic characteristics and a lower rate of impaired consciousness and cardiac arrests, as compared with unsuccessful interventions in the same age group. CONCLUSIONS Our study showed a 46.6% success rate for abdominal thrusts in patients with FBAO. The success group had a lower proportion of impaired consciousness and cardiopulmonary arrest than the failure group. Future studies should attempt to identify the most effective maneuvers for clearing airway obstruction.
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Affiliation(s)
- Ryotaro Suga
- Department of Emergency Medical Science, Nippon Sport Science University
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Shinnosuke Kitano
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Kensuke Suzuki
- Department of Emergency Medical Science, Nippon Sport Science University
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Satoo Ogawa
- Department of Emergency Medical Science, Nippon Sport Science University
| | - Hiroyuki Yokota
- Department of Emergency Medical Science, Nippon Sport Science University
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Martínez-Isasi S, Carballo-Fazanes A, Jorge-Soto C, Otero-Agra M, Fernández-Méndez F, Barcala-Furelos R, Izquierdo V, García-Martínez M, Rodríguez-Núñez A. School children brief training to save foreign body airway obstruction. Eur J Pediatr 2023; 182:5483-5491. [PMID: 37777603 PMCID: PMC10746610 DOI: 10.1007/s00431-023-05202-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/31/2023] [Accepted: 09/09/2023] [Indexed: 10/02/2023]
Abstract
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.
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Affiliation(s)
- Santiago Martínez-Isasi
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Simulation, Life Support, and Intensive Care Research Unit, (SICRUS) of the Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Faculty of Nursing, Universidade de Santiago de Compostela, Av/Xoan XXIII, S/N, 15782, Santiago de Compostela, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, RD21/0012/0025, Madrid, Spain
| | - Aida Carballo-Fazanes
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
- Simulation, Life Support, and Intensive Care Research Unit, (SICRUS) of the Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
- Faculty of Nursing, Universidade de Santiago de Compostela, Av/Xoan XXIII, S/N, 15782, Santiago de Compostela, Spain.
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, RD21/0012/0025, Madrid, Spain.
| | - Cristina Jorge-Soto
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Simulation, Life Support, and Intensive Care Research Unit, (SICRUS) of the Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Faculty of Nursing, Universidade de Santiago de Compostela, Av/Xoan XXIII, S/N, 15782, Santiago de Compostela, Spain
| | - Martín Otero-Agra
- REMOSS Research Group, Faculty of Education and Sport Sciences, Universidade de Vigo, Pontevedra, Spain
- Escuela de Enfermería de Pontevedra, Universidade de Vigo, Pontevedra, Spain
| | - Felipe Fernández-Méndez
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- REMOSS Research Group, Faculty of Education and Sport Sciences, Universidade de Vigo, Pontevedra, Spain
- Escuela de Enfermería de Pontevedra, Universidade de Vigo, Pontevedra, Spain
| | - Roberto Barcala-Furelos
- REMOSS Research Group, Faculty of Education and Sport Sciences, Universidade de Vigo, Pontevedra, Spain
| | - Verónica Izquierdo
- Simulation, Life Support, and Intensive Care Research Unit, (SICRUS) of the Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, RD21/0012/0025, Madrid, Spain
| | | | - Antonio Rodríguez-Núñez
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Simulation, Life Support, and Intensive Care Research Unit, (SICRUS) of the Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Faculty of Nursing, Universidade de Santiago de Compostela, Av/Xoan XXIII, S/N, 15782, Santiago de Compostela, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, RD21/0012/0025, Madrid, Spain
- Pediatric Critical, Intermediate and Palliative Care Section, Pediatric Area, Santiago de Compostela's University Clinic Hospital, Santiago de Compostela, Spain
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Khan S, Patterson K, Fidler K. Service evaluation: identification of gaps in choking prevention advice for children in the South Coast of England, UK. Fam Med Community Health 2023; 11:e001966. [PMID: 37813545 PMCID: PMC10565162 DOI: 10.1136/fmch-2022-001966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Affiliation(s)
- Saira Khan
- Medical Teaching Building, Brighton and Sussex Medical School, Brighton, UK
| | - Karen Patterson
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Katy Fidler
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
- Academic Department of Paediatrics, Royal Alexandra Children's Hospital, Brighton, UK
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Characteristics and Outcomes of Emergency Transferred Patients with Foreign Body Airway Obstruction in Tokyo, Japan. Prehosp Disaster Med 2023:1-6. [PMID: 36938681 DOI: 10.1017/s1049023x23000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
INTRODUCTION 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. STUDY OBJECTIVE The aim of this study was to investigate whether characteristics of patients with FBAO were associated with prehospital factors and outcomes. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Miyoshi T, Endo H, Yamamoto H, Shimada K, Kumamaru H, Ichihara N, Miyachi Y, Miyata H. Long-term prognosis and clinical course of choking-induced cardiac arrest in patients without the return of spontaneous circulation at hospital arrival: a population-based community study from the Shizuoka Kokuho Database. BMC Emerg Med 2022; 22:120. [PMID: 35794516 PMCID: PMC9258190 DOI: 10.1186/s12873-022-00676-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/16/2022] [Indexed: 02/06/2023] Open
Abstract
Background The risk of choking increases with aging, and the number of cases of choking-induced cardiac arrest is increasing. However, few studies have examined the prognosis of choking-induced cardiac arrest. The aim of this study was to reveal the rates of survival and dependence on devices in the long term after choking-induced cardiac arrest. Methods We analyzed data from the Shizuoka Kokuho Database, which consists of claims data of approximately 2.2 million people, from April 2012 to September 2018. We selected patients with choking-induced cardiac arrest who received cardiopulmonary resuscitation in the hospital. Patients were excluded if they were less than 20 years old, had an upper airway tumor, received ventilation assistance, or received enteral nutrition in the month prior to cardiac arrest. The primary outcome was death, and the secondary outcomes were the rates of survival at 3-months and independence on devices. Descriptive statistics are presented and compared among age groups (20–64 years, 65–74 years, 75–84 years, 85 years and older), and survival time analysis (Kaplan-Meier method) was performed. Results In total, 268 patients were analyzed, including 26 patients in the 20–64 age group, 33 patients in the 65–74 age group, 70 patients in the 75–84 age group, and 139 patients in the ≥85 age group. The overall 3-month survival rate was 5.6% (15/268). The 3-month survival rates were 3.8% (1/26) in the 20–64 age group, 15.2% (5/33) in the 65–74 age group, 8.6% (6/70) in the 75–84 age group, and 2.2% (3/139) in the ≥85 age group. The overall 12-month survival rate was 2.6% (7/268). Of the 7 patients who survived for 12 months, 3 received ventilation management and 5 received tube or intravenous feedings at 3 months. These survivors were still receiving ventilation assistance and tube feedings in the hospital and had not been discharged at 12 months. Conclusions The prognosis of choking-induced cardiac arrest was extremely poor when patients were not resuscitated before hospital arrival. Those who survived were mostly dependent on assistive devices. Additionally, none of the survivors dependent on assistive devices had discontinued the use of the devices at the long-term follow-up. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00676-8.
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Katabami K, Kimura T, Hirata T, Tamakoshi A. Risk Factors of Mortality from Foreign Bodies in the Respiratory Tract: The Japan Collaborative Cohort Study. Intern Med 2022; 61:1353-1359. [PMID: 35491176 PMCID: PMC9152875 DOI: 10.2169/internalmedicine.8437-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective This study assessed the risk factors of mortality from foreign bodies in the respiratory tract using the Japan Collaborative Cohort Study for the Evaluation of Cancer Risk data. Methods Data of 110,585 participants 40-79 years old living in 45 areas in Japan were collected between 1988 and 2009. Mortality from foreign bodies in the respiratory tract was assessed in a multivariable-adjusted analysis using a Cox proportional hazard regression model. Results Among all participants, 202 deaths occurred from foreign bodies in the respiratory tract. In the multivariable-adjusted model, older age [50-59 (hazard ratio, 4.93; 95% confidence interval, 1.91-12.74), 60-69 (hazard ratio, 14.96, 6.01-37.25) and 70-79 (hazard ratio, 53.81; 95% confidence interval, 21.44-135.02) years old compared to 40-49 years old], male sex (hazard ratio, 2.34; 95% confidence interval, 1.54-3.54), a history of apoplexy (hazard ratio, 7.04; 95% confidence interval, 4.24-11.67) and the absence of a spouse (hazard ratio, 1.56; 95% confidence interval, 1.05-2.32) were associated with an increased risk of mortality from foreign bodies in the respiratory tract. Conclusions Older age, male sex, medical history of apoplexy and the absence of a spouse were potential risk factors of mortality from foreign bodies in the respiratory tract. Especially in elderly men, social connections, such as cohabitation or relationships, may be important for ensuring the early detection of asphyxia and preventing death due to foreign bodies in the respiratory tract.
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Affiliation(s)
- Kenichi Katabami
- Department of Public Health, Hokkaido University Graduate School of Medicine, Japan
| | - Takashi Kimura
- Department of Public Health, Hokkaido University Graduate School of Medicine, Japan
| | - Takumi Hirata
- Department of Public Health, Hokkaido University Graduate School of Medicine, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Graduate School of Medicine, Japan
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Katsuki M. Sliced Lotus Root as a Hypopharyngeal Foreign Body. Cureus 2021; 13:e19296. [PMID: 34900475 PMCID: PMC8648297 DOI: 10.7759/cureus.19296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
Pharyngeal foreign bodies are medical emergencies that require airway protection. Rapid diagnosis and adequate treatment are needed. However, in elderly patients with dementia, diagnosing foreign body aspiration sometimes seems difficult only from the medical history, so we should maintain a high degree of suspicion when treating patients with unexplained symptoms. We herein present a 95-year-old woman with hypersalivation and sore throat two hours after dinner. Due to her mild dementia, sufficient medical history could not be obtained. She could walk and talk, but could not swallow. Her vital signs were all within normal limits. There were no abnormal findings in the oral cavity. The neck x-ray images revealed the patent airway and foreign body in the hypopharynx. We used Macintosh laryngoscope and Magill forceps to remove the foreign body, which was a sliced lotus root with a diameter of 61 mm. After removal, she could swallow, and her symptoms rapidly improved. We should suspect this if the patient presents unexplained pharyngeal symptoms.
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Maalim Issack A, Jiru T, Wubetie Aniley A. Assessment of knowledge, attitude and practice on first aid management of choking and associated factors among kindergarten teachers in Addis Ababa governmental schools, Addis Ababa, Ethiopia. A cross-sectional institution-based study. PLoS One 2021; 16:e0255331. [PMID: 34329362 PMCID: PMC8323944 DOI: 10.1371/journal.pone.0255331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 07/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Choking refers to a blockage of upper airways by food or other objects resulting in interruption of breathing. It is a medical emergency that needs immediate action by anyone near by the victim to save life. Chocking is a major cause of illness and death in the pediatric population under the age of 5 years. Children at this age spent more time in their school and are at high risk during their feeding and playing. Immediate provision of first aid in response to choking by a preschool teacher will help to decrease the risk of developing life-threatening complications, length of hospital stays, the cost of treatment, and death. METHODS Institutional-based cross-sectional study design was applied to the study area using pretested, structured, and self-administered questionnaires. The collected data were analyzed using SPSS version 25. Multiple logistic regression analysis was used to identify factors associated with Knowledge, attitude, and practice of kindergarten teachers towards first aid management of choking. RESULTS A total of 224 Kindergarten teachers were involved in the study with a response rate of 95%. Only eighty-three (37%) of them were knowledgeable and 97 (43.3%) have faced a choked child in the school compound. Of these, only 42 (43.2%) had provided first aid to the victim. Most of the respondents 95.1% had a positive attitude towards choking first aid and 57.1% of them agreed that choking needs immediate management. Multiple logistic regression analysis showed that Kindergarten teachers with the previous first aid training were 2.9 times more knowledgeable than those kindergarten teachers without previous first aid training (AOR: 2.902, 95% CI: 1.612, 5.227). CONCLUSIONS The level of knowledge and skills for providing first aid for choking children among kindergarten teachers is low. There is a need for urgent intervention to train teachers regarding the provision of first aid for choking children.
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Affiliation(s)
- Ali Maalim Issack
- Department of Nursing, College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia
| | - Tilahun Jiru
- Department of Emergency Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Andualem Wubetie Aniley
- Department of Emergency Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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12
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Patterson E, Tang HT, Ji C, Perkins GD, Couper K. The efficacy and usability of suction-based airway clearance devices for foreign body airway obstruction: a manikin randomised crossover trial. Resusc Plus 2021; 5:100067. [PMID: 34223337 PMCID: PMC8244487 DOI: 10.1016/j.resplu.2020.100067] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background Newly-developed suction-based airway clearance devices potentially provide a novel way to improve outcome in patients with foreign body airway obstruction. We conducted a randomised controlled crossover manikin trial to compare the efficacy and usability of two of these devices with abdominal thrusts. Methods We randomised participants from a UK medical school to one of six groups which determined the order in which participants attempted the three techniques (abdominal thrusts; LifeVac, Nesconset, New York, USA; Dechoker, Concord North Carolina, USA). Randomisation was performed using an online randomisation system. Following brief training, participants sought to remove a foreign body airway obstruction from a manikin using the allocated technique. The primary outcome was successful removal of the foreign body. Usability was assessed in a questionnaire following the three simulations. Results We randomised and analysed data from 90 participants (58% male; 86% aged 18−29 years). Compared with abdominal thrusts, successful foreign body airway obstruction removal was achieved more frequently in manikins in the LifeVac group (odds ratio 47.32, 95% CI 5.75–389.40) but not in the Dechoker group (odds ratio 1.22, 95% CI 0.60–2.47). The usability of LifeVac and abdominal thrusts were generally evaluated more positively than the Dechoker. Conclusion In this manikin study, we found that, compared with abdominal thrusts, the success rate for foreign body airway obstruction removal was higher in the LifeVac group but not in the Dechoker group.
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Affiliation(s)
- Emma Patterson
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Ho Tsun Tang
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Chen Ji
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK.,Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Keith Couper
- Warwick Medical School, University of Warwick, Coventry, UK.,Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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13
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Couper K, Abu Hassan A, Ohri V, Patterson E, Tang HT, Bingham R, Olasveengen T, Perkins GD. Removal of foreign body airway obstruction: A systematic review of interventions. Resuscitation 2020; 156:174-181. [PMID: 32949674 DOI: 10.1016/j.resuscitation.2020.09.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/06/2020] [Accepted: 09/09/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To summarise in a systematic review the effectiveness of interventions to treat foreign body airway obstructions (FBAO). METHODS We searched MEDLINE, EMBASE, and the Cochrane library from inception on 30th September 2019 for studies that described the effectiveness of interventions to treat FBAO in adults and children. We included randomised controlled trials, observational studies and case series (≥5 cases) that described evidence of benefit. For evidence of harm/complications, we included case reports. Two reviewers independently assessed study eligibility, extracted study data, and assessed risk of bias. Data are summarised in a narrative synthesis. The GRADE system is used to assess evidence certainty. RESULTS We included 69 publications, comprising three cross-sectional studies (557 patients); eight case series (755 patients), and 59 were case reports (64 patients). One paper was included as a case series and cross-sectional study. For all interventions and associated outcomes, evidence certainty was very low. Early removal of FBAO by bystanders was associated with improved neurological survival (odds ratio 6.0, 95% confidence interval 1.5 to 23.4). Identified evidence showed that key interventions (back blows, abdominal thrusts, chest thrusts/compressions, Magill forceps, manual removal of obstructions from the mouth, suction-based airway clearance devices) are effective in relieving FBAO. We identified reports of harm in relation to back blows, abdominal thrusts, chest thrusts/compressions, and blind finger sweeps. CONCLUSIONS Key interventions successfully relieve FBAO, but may be associated with important harms. Guidelines for FBAO management should balance the benefits and harms of interventions.
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Affiliation(s)
- Keith Couper
- Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Vrinda Ohri
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Emma Patterson
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Ho Tsun Tang
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Robert Bingham
- Paediatric Anaesthetisia, Great Ormond Street Hospital for Children, London, UK
| | - Theresa Olasveengen
- Department of Anaesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
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14
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Norii T, Igarashi Y, Sung-Ho K, Nagata S, Tagami T, Yoshino Y, Hamaguchi T, Maejima R, Nakao S, Albright D, Yokobori S, Yokota H, Shimazu T, Crandall C. Protocol for a nationwide prospective, observational cohort study of foreign-body airway obstruction in Japan: the MOCHI registry. BMJ Open 2020; 10:e039689. [PMID: 32690753 PMCID: PMC7375623 DOI: 10.1136/bmjopen-2020-039689] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Foreign body airway obstruction (FBAO) is a major public health issue worldwide. In 2017, there were more than 5000 fatal choking cases in the USA alone, and it was the fourth leading cause of preventable injury-related death in the home and community. In Japan, FBAO is the leading cause of accidental death and with almost 9000 fatalities annually. However, research on FBAO is limited, particularly on the impact of a foreign body (FB) removal manoeuvres by bystanders. The primary objective of this study is to determine the impact of bystander FB removal manoeuvres on 1 month neurological outcome. Our secondary objectives include (1) evaluating the efficacy of a variety of FB removal manoeuvres; (2) identifying risk factors for unsuccessful removal and (3) evaluating the impact of time intervals from incidents of FBAO to FB removal on neurological outcome. METHODS AND ANALYSIS We will conduct a nationwide multi-centre prospective cohort study of patients with FBAO who present to approximately 100 emergency departments in both urban and rural areas in Japan. Research personnel at each participating site will collect variables including patient demographics, type of FB and prehospital variables, such as bystander FB removal manoeuvres, medical interventions by prehospital personnel, advanced airway management and diagnostic findings. Our primary outcome is 1 month favourable neurological outcome defined as cerebral performance category 1 or 2. Our secondary outcomes include success of FB removal manoeuvres and complications from the manoeuvres. We hypothesise that bystander FB removal manoeuvres improve patient survival with a favourable neurological outcome. ETHICS AND DISSEMINATION This study received research ethics approval from Nippon Medical School Hospital (B-2019-019). Research ethics approval will be obtained from all participating sites before entering patients into the registry. The study was registered at the University Hospital Medical Information Network (UMIN) Clinical Trials Registry. TRIAL REGISTRATION NUMBER UMIN 000039907.
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Affiliation(s)
- Tatsuya Norii
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Bunkyo-ku, Tokyo, Japan
| | - Kim Sung-Ho
- Department of Critical Care Medicine, Osaka Habikino Medical Center, Habikino, Osaka, Japan
| | - Shimpei Nagata
- Department of Emergency Medicine, Osaka Police Hospital, Osaka, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Yudai Yoshino
- Department of Emergency Medicine, Aidu Chuo Hospital, Aizuwakamatsu, Fukushima, Japan
| | - Takuro Hamaguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Riko Maejima
- Department of Emergency Medicine, Japanese Red Cross Ashikaga Hospital, Ashikaga, Tochigi, Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Danielle Albright
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Bunkyo-ku, Tokyo, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Cameron Crandall
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
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15
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Taniguchi Y, Iwagami M, Sakata N, Watanabe T, Abe K, Tamiya N. Epidemiology of Food Choking Deaths in Japan: Time Trends and Regional Variations. J Epidemiol 2020; 31:356-360. [PMID: 32536639 PMCID: PMC8021878 DOI: 10.2188/jea.je20200057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background With increasing age globally, more people may become vulnerable to food choking. We investigated the nationwide epidemiology of food choking deaths in Japan. Methods Using Japanese Vital Statistics death data between 2006 and 2016, we identified food choking deaths based on the 10th revision of the International Statistical Classification of Diseases code W79 (Inhalation and ingestion of food causing obstruction of respiratory tract) as a primary diagnosis. We assessed the demographics of people with food choking deaths; temporal trends of food choking deaths by the year (overall and by age group), the day of year; and prefecture variations. Results Overall, 52,366 people experienced food choking deaths (median age, 82 years, 53% were male, and 57% occurred at home). The highest numbers occurred January 1–3, and were lowest in June. Despite a stable total number of cases at around 4,000 yearly, from 2006 to 2016 the incidence proportion declined from 16.2 to 12.1 per 100,000 population among people aged 75–84 years. Among people ≥85 years, the incidence proportion peaked at 53.5 in 2008 and decreased to 43.6 in 2016. The number of food choking deaths varied by prefecture. Conclusions There are temporal and regional variations of food choking deaths in Japan, possibly due to the consumption of Japanese rice cake (mochi), particularly over the New Year’s holiday.
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Affiliation(s)
- Yuta Taniguchi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba.,Health Services Research and Development Center, University of Tsukuba
| | - Nobuo Sakata
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba.,Health Services Research and Development Center, University of Tsukuba
| | - Taeko Watanabe
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba.,Health Services Research and Development Center, University of Tsukuba
| | - Kazuhiro Abe
- Department of Public Health, Graduate School of Medicine, The University of Tokyo
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba.,Health Services Research and Development Center, University of Tsukuba
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16
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Igarashi Y, Norii T, Sung-Ho K, Nagata S, Yokota H. Seasonal choking in Japan: Japanese rice cake (mochi), ehomaki, and beans for Setsubun. Resuscitation 2020; 150:90-91. [PMID: 32244007 DOI: 10.1016/j.resuscitation.2020.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
| | - Tatsuya Norii
- Department of Emergency Medicine, University of New Mexico, Albuquerque, USA.
| | - Kim Sung-Ho
- Department of Intensive Care Medicine, Osaka Habikino Medical Center, Osaka, Japan.
| | - Shimpei Nagata
- Department of Emergency Medicine, Osaka Police Hospital, Osaka, Japan.
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan.
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