1
|
Parri N, Madera A, D'Aiuto F, Zampogna S, Milani GP. Systematic review shows that suction-based airway clearance devices for foreign body airway obstruction are promising. Acta Paediatr 2024; 113:1701-1702. [PMID: 38563507 DOI: 10.1111/apa.17229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/04/2024]
Affiliation(s)
| | - Anna Madera
- Department of Pediatric, Carlo Poma Hospital, Mantova, Italy
| | - Francesca D'Aiuto
- Pediatric Emergency Unit, Di Cristina Children's Hospital, Azienda di Rilievo Nazionale e di Alta Specializzazione Civico Di Cristina Benfratelli, Palermo, Italy
| | | | - Gregorio Paolo Milani
- Department of Health Science and Community Health, University of Milan, Milan, Italy
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
2
|
Dunne CL, Viguers K, Osman S, Queiroga AC, Szpilman D, Peden AE. A 2-year prospective evaluation of airway clearance devices in foreign body airway obstructions. Resusc Plus 2023; 16:100496. [PMID: 38026136 PMCID: PMC10658362 DOI: 10.1016/j.resplu.2023.100496] [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: 10/11/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Aim To collect, analyze and report the first prospective, industry-independent, data on airway clearance devices as novel foreign body airway obstruction interventions. Methods We 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. Results We 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). Conclusion Within 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.
Collapse
Affiliation(s)
- Cody L Dunne
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
- International Drowning Researchers’ Alliance, Kuna, Idaho, USA
| | - Kayla Viguers
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Selena Osman
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ana Catarina Queiroga
- International Drowning Researchers’ Alliance, Kuna, Idaho, USA
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto Portugal
| | - David Szpilman
- International Drowning Researchers’ Alliance, Kuna, Idaho, USA
- Brazilian Lifesaving Society (SOBRASA), Barra da Tijuca, Rio de Janeiro, Brazil
| | - Amy E Peden
- International Drowning Researchers’ Alliance, Kuna, Idaho, USA
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| |
Collapse
|
3
|
Ramaswamy A, Done A, Solis R, Srikanth M, Olinde L, Belafsky P. The efficacy of two commercially available devices for airway foreign body relief: A cadaver study. Laryngoscope Investig Otolaryngol 2023; 8:708-711. [PMID: 37342119 PMCID: PMC10278115 DOI: 10.1002/lio2.1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/31/2023] [Indexed: 06/22/2023] Open
Abstract
Objective Foreign body aspiration events are frequent in young children and in the geriatric population. They may result in several complications such as hypoxia, edema, cardiac arrest, and death. Recently, two commercially available devices, the LifeVac and DeChoker, have entered the market with the claim of relieving foreign body aspiration. Both devices are portable, nonpowered, suction devices that are being considered for use in large public spaces such as schools, airports, and malls despite previous studies detailing variable efficacy. In this study, we aim to contribute further data on the safety and efficacy of these devices through a fresh cadaver model. Methods Commonly aspirated foods of three different sizes (saltines, grapes, and cashews) were placed at the level of the true vocal folds in a fresh cadaver. Three participants performed two trials with each food and device. Device use was performed to manufacturer specifications. Results The DeChoker resulted in gross injury to the tongue and failed to remove the obstruction in all trials. LifeVac was successful in removing the barium-moistened saltines but failed to remove all other foreign bodies. Both devices applied significant pressure to the tongue. Conclusion With the exception of the LifeVac removing saltine crackers, all trials were entirely unsuccessful in relieving foreign body aspiration. Additionally, both devices may cause significant pressure and injury to the oral cavity in a clinical setting. We conclude bystanders should continue to follow International Liaison Committee on Resuscitation's guidelines on resuscitation to aid with relieving foreign body aspiration. Level of Evidence 4.
Collapse
Affiliation(s)
- Apoorva Ramaswamy
- Department of Otolaryngology, Center for Voice and SwallowUniversity of California, DavisSacramentoCaliforniaUSA
- Department of OtolaryngologyThe Ohio State UniversityColumbusOhioUSA
| | - Aaron Done
- Department of Otolaryngology, Center for Voice and SwallowUniversity of California, DavisSacramentoCaliforniaUSA
| | - Roberto Solis
- Department of Otolaryngology, Center for Voice and SwallowUniversity of California, DavisSacramentoCaliforniaUSA
| | - Mayuri Srikanth
- Department of OtolaryngologyThe Ohio State UniversityColumbusOhioUSA
| | - Lindsay Olinde
- Department of Otolaryngology, Center for Voice and SwallowUniversity of California, DavisSacramentoCaliforniaUSA
| | - Peter Belafsky
- Department of Otolaryngology, Center for Voice and SwallowUniversity of California, DavisSacramentoCaliforniaUSA
| |
Collapse
|
4
|
Cardalda-Serantes B, Carballo-Fazanes A, Rodríguez-Ruiz E, Abelairas-Gómez C, Rodríguez-Núñez A. Would anti-choking devices be correctly and quickly managed by health science students? A manikin crossover trial. BMC MEDICAL EDUCATION 2023; 23:365. [PMID: 37221498 DOI: 10.1186/s12909-023-04345-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 05/10/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The 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. METHODS Forty-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. RESULTS Participants 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). CONCLUSIONS Untrained 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.
Collapse
Affiliation(s)
- Borja Cardalda-Serantes
- Anesthesiology and Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
| | - Aida Carballo-Fazanes
- CLINURSID Research Group, University of Santiago de Compostela, 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.
- Simulation, Life Support, and Intensive Care Research Unit (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - Emilio Rodríguez-Ruiz
- CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain
- Simulation, Life Support, and Intensive Care Research Unit (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
| | - Cristian Abelairas-Gómez
- CLINURSID Research Group, University of Santiago de Compostela, 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
- Simulation, Life Support, and Intensive Care Research Unit (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Faculty of Education Sciences, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonio Rodríguez-Núñez
- CLINURSID Research Group, University of Santiago de Compostela, 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
- Simulation, Life Support, and Intensive Care Research Unit (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
- Pediatric Critical, Intermediate and Palliative Care Section, Pediatric Department. Hospital, Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| |
Collapse
|
5
|
Dunne CL, Osman S, Viguers K, Queiroga AC, Szpilman D, Peden AE. Phase One of a Global Evaluation of Suction-Based Airway Clearance Devices in Foreign Body Airway Obstructions: A Retrospective Descriptive Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073846. [PMID: 35409529 PMCID: PMC8998090 DOI: 10.3390/ijerph19073846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023]
Abstract
Background: Choking is a prevalent source of injury and mortality worldwide. Traditional choking interventions, including abdominal thrusts and back blows, have remained the standard of care for decades despite limited published data. Suction-based airway clearance devices (ACDs) are becoming increasingly popular and there is an urgent need to evaluate their role in choking intervention. The aim of this study was to describe the effectiveness (i.e., resolution of choking symptoms) and safety (i.e., adverse events) of identified airway clearance devices interventions to date. Methods: This retrospective descriptive analysis included any individual who self-identified to manufacturers as having used an ACD as a choking intervention prior to 1 July 2021. Records were included if they contained three clinical variables (patient’s age, type of foreign body, and resolution of choking symptoms). Researchers performed data extraction using a standardized form which included patient, situational, and outcome variables. Results: The analysis included 124 non-invasive (LifeVac©) and 61 minimally invasive (Dechoker©) ACD interventions. Median patient age was 40 (LifeVac©, 2−80) and 73 (Dechoker©, 5−84) with extremes of age being most common [<5 years: LifeVac© 37.1%, Dechoker© 23.0%; 80+ years: 27.4%, 37.7%]. Food was the most frequent foreign body (LifeVac© 84.7%, Dechoker© 91.8%). Abdominal thrusts (LifeVac© 37.9%, Dechoker© 31.1%) and back blows (LifeVac© 39.5%, Dechoker© 41.0%) were often co-interventions. Resolution of choking symptoms occurred following use of the ACD in 123 (LifeVac©) and 60 (Dechoker©) cases. Three adverse events (1.6%) were reported: disconnection of bellows/mask during intervention (LifeVac©), a lip laceration (Dechoker©), and an avulsed tooth (Dechoker©). Conclusion: Initial available data has shown ACDs to be promising in the treatment of choking. However, limitations in data collection methods and quality exist. The second phase of this evaluation will be an industry independent, prospective assessment in order to improve data quality, and inform future choking intervention algorithms.
Collapse
Affiliation(s)
- Cody L. Dunne
- Department of Emergency Medicine, University of Calgary, Calgary, AB T2N2T9, Canada
- International Drowning Researchers’ Alliance, Kuna, ID 83634, USA; (A.C.Q.); (D.S.); (A.E.P.)
- Correspondence:
| | - Selena Osman
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N4N1, Canada;
| | - Kayla Viguers
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1C5S7, Canada;
| | - Ana Catarina Queiroga
- International Drowning Researchers’ Alliance, Kuna, ID 83634, USA; (A.C.Q.); (D.S.); (A.E.P.)
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, 4050-600 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4200-319 Porto, Portugal
| | - David Szpilman
- International Drowning Researchers’ Alliance, Kuna, ID 83634, USA; (A.C.Q.); (D.S.); (A.E.P.)
- Brazilian Lifesaving Society (SOBRASA), Barra da Tijuca, Rio de Janeiro 22631-004, Brazil
| | - Amy E. Peden
- International Drowning Researchers’ Alliance, Kuna, ID 83634, USA; (A.C.Q.); (D.S.); (A.E.P.)
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
| |
Collapse
|