Foreign body airway obstructions (FBAO) are a critical emergency that can lead to severe consequences, including death, if not promptly addressed. Rapid and effective intervention by bystanders is essential for improving survival rates. This study evaluates the effectiveness of various basic life support (BLS) techniques used by lay rescuers and paramedics in resolving FBAO and ensuring patient survival until hospital discharge.
Introduction
Foreign body airway obstructions (FBAO), commonly known as choking, represent a significant cause of morbidity and mortality worldwide. When an individual accidentally ingests an object that blocks the airway, it can rapidly lead to unconsciousness, respiratory arrest, and death if not promptly addressed. Early intervention by bystanders can significantly improve survival rates. However, the optimal practices for bystander interventions are not well-defined. This study aims to bridge this gap by providing high-quality data on the effectiveness of basic interventions in FBAO cases.
Study Objectives
The primary objective of the study was to quantify the associations between different basic life support (BLS) techniques for foreign body airway obstructions and the resolution of the obstruction, as well as survival until hospital discharge. The BLS interventions analyzed included abdominal thrusts, chest compressions, and back blows.
Foreign body airway obstructions (FBAO) are a critical emergency that can lead to severe consequences, including death, if not promptly addressed. Rapid and effective intervention by bystanders is essential for improving survival rates. Interestingly, some guidelines have removed back blows for adults, while others retain them for all age groups. This study evaluates the effectiveness of various basic life support (BLS) techniques used by lay rescuers and paramedics in resolving FBAO and ensuring patient survival until hospital discharge. It is crucial to base practices on statistics and demonstrated case studies like this one to inform and refine resuscitation guidelines.
Methodology
This observational cohort study utilized administrative health data and electronic medical records to identify out-of-hospital FBAO cases in the province of Alberta, Canada, between January 1, 2018, and December 31, 2021. Alberta Health Services, the provincial health authority, provided the data through the electronic medical record system of emergency medical services (EMS).
Two experienced physicians reviewed the records to determine FBAO cases and extract the necessary data. Statistical analyses, including multivariate logistic regressions, were used to determine the adjusted odds of FBAO resolution and survival to hospital discharge.
Results
The study identified a total of 3,677 patient encounters, of which 709 FBAO cases required intervention. Lay rescuers performed the initial BLS intervention in 77.4% of cases. However, obstructions were not resolved by lay rescuers in 23.5% of cases and by paramedics in 16.7% of cases. This underscores the importance of timely and effective intervention by lay rescuers.
The analyses revealed that FBAO cases not resolved before the paramedic’s arrival were associated with a significantly higher proportion of deaths compared to those resolved earlier (42.4% vs. 0.4%). This finding highlights the critical importance of immediate intervention to improve survival chances.
Abdominal thrusts and chest compressions were associated with a decrease in the odds of FBAO resolution compared to back blows. Abdominal thrusts had an adjusted odds ratio of 0.49 (95% CI 0.30-0.80), while chest compressions had an odds ratio of 0.14 (95% CI 0.07-0.28). Additionally, chest compressions were significantly associated with reduced odds of survival to hospital discharge, with an adjusted odds ratio of 0.04 (95% CI 0.01-0.32).
Regarding injuries associated with interventions, four cases of injuries were identified for abdominal thrusts, nine for chest compressions, and none for back blows. This suggests that back blows are not only more effective but also safer than the other techniques.
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Discussion
The study’s findings provide significant evidence that back blows are the most effective BLS intervention for resolving FBAO and improving survival chances. This is crucial information for lay rescuers, who are often the first responders in choking emergencies. Training in resuscitation should thus emphasize the use of back blows as the primary technique for resolving FBAO.
The relatively low effectiveness of abdominal thrusts and chest compressions observed in the study suggests the need for further research to optimize these techniques or to develop new intervention strategies. Additionally, the higher incidence of injuries associated with these techniques underscores the need for accurate training to minimize risks.
Conclusions
Foreign body airway obstructions are an emergency condition requiring immediate and effective intervention. This study has demonstrated that back blows are associated with better outcomes compared to abdominal thrusts and chest compressions, in terms of both obstruction resolution and survival to hospital discharge. The findings can inform resuscitation guidelines and improve lay rescuer training, contributing to saving lives in choking emergencies.