Keith Couper1, Aysha Abu Hassan2, Vrinda Ohri2, Emma Patterson2, Ho Tsun Tang2, Robert Bingham3, Theresa Olasveengen4, Gavin D Perkins5. 1. Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. 2. Warwick Medical School, University of Warwick, Coventry, UK. 3. Paediatric Anaesthetisia, Great Ormond Street Hospital for Children, London, UK. 4. Department of Anaesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 5. Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. Electronic address: g.d.perkins@warwick.ac.uk.
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.
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.
Authors: Theresa M Olasveengen; Federico Semeraro; Giuseppe Ristagno; Maaret Castren; Anthony Handley; Artem Kuzovlev; Koenraad G Monsieurs; Violetta Raffay; Michael Smyth; Jasmeet Soar; Hildigunnur Svavarsdóttir; Gavin D Perkins Journal: Notf Rett Med Date: 2021-06-02 Impact factor: 0.826
Authors: Cody L Dunne; Selena Osman; Kayla Viguers; Ana Catarina Queiroga; David Szpilman; Amy E Peden Journal: Int J Environ Res Public Health Date: 2022-03-24 Impact factor: 3.390
Authors: Jasmeet Soar; Bernd W Böttiger; Pierre Carli; Keith Couper; Charles D Deakin; Therese Djärv; Carsten Lott; Theresa Olasveengen; Peter Paal; Tommaso Pellis; Gavin D Perkins; Claudio Sandroni; Jerry P Nolan Journal: Notf Rett Med Date: 2021-06-08 Impact factor: 0.826