31 Out-of-hospital treatment of acute foreign body airway obstruction in adults: a structured literature review

Aim There were 4700 deaths due to choking in the United States in 2012. This study was a structured literature review with the objective of determining whether in adults, either conscious or unconscious, with acute foreign body airway obstructions, if any specific resuscitation technique, compared to other techniques, leads to different outcomes. Method We developed an a priori search definition, and searched PubMed, Google, and OneSearch@IU. We sought additional articles by reviewing the reference lists of articles that we included. We included articles if they addressed original research of treatment of foreign body airway obstruction in adults. We excluded articles if the skill was not applicable to an out-of-hospital rescuer or if there was no abstract available in English. For those articles that met our criteria, two investigators independently collected the results and assessed the quality of the evidence. Results We identified 534 articles for screening and performed full-text reviews on 64. We included 44 articles in our qualitative synthesis. We found one fair quality study that supported the use of abdominal thrusts, two fair quality studies that supported back blows, and one fair quality study that supported chest thrusts. Conclusion Rescuers attempting to resolve a complete foreign body airway obstruction in a conscious adult should provide back blows and either abdominal and/or chest thrusts to the victim. Rescuers attempting to resolve a complete foreign body airway obstruction in an unconscious adult should provide CPR and use a finger sweep if a foreign body is seen in the mouth. Conflict of interest RNB and SL are both employed by their respective medical schools. Some travel expenses are reimbursed as SL is a member and RNB is the chair of the Resuscitation Subcouncil of the American Red Cross Scientific Advisory Council. Funding None