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A systematic review on the effectiveness of anti-choking suction devices and identification of research gaps

  • Author Footnotes
    1 All authors are affiliated with the International Drowning Researchers’ Alliance (IDRA).
    C.L. Dunne
    Correspondence
    Corresponding author at: Department of Emergency Medicine, Foothills Medical Center, 1409 – 29 St NW, Calgary, AB T2N2T9, Canada.
    Footnotes
    1 All authors are affiliated with the International Drowning Researchers’ Alliance (IDRA).
    Affiliations
    Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada

    Medical Committee, International Life Saving Federation, Belgium
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  • Author Footnotes
    1 All authors are affiliated with the International Drowning Researchers’ Alliance (IDRA).
    A.E. Peden
    Footnotes
    1 All authors are affiliated with the International Drowning Researchers’ Alliance (IDRA).
    Affiliations
    School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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  • Author Footnotes
    1 All authors are affiliated with the International Drowning Researchers’ Alliance (IDRA).
    A.C. Queiroga
    Footnotes
    1 All authors are affiliated with the International Drowning Researchers’ Alliance (IDRA).
    Affiliations
    EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
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  • Author Footnotes
    1 All authors are affiliated with the International Drowning Researchers’ Alliance (IDRA).
    C. Gomez Gonzalez
    Footnotes
    1 All authors are affiliated with the International Drowning Researchers’ Alliance (IDRA).
    Affiliations
    CLINURSID Research Group, University of Santiago de Compostela, Spain
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  • Author Footnotes
    1 All authors are affiliated with the International Drowning Researchers’ Alliance (IDRA).
    B. Valesco
    Footnotes
    1 All authors are affiliated with the International Drowning Researchers’ Alliance (IDRA).
    Affiliations
    Office of Public Health Preparedness, Maui District Health, Hawaii State Health Department, Wailuku, Hawaii, United States
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  • Author Footnotes
    1 All authors are affiliated with the International Drowning Researchers’ Alliance (IDRA).
    D. Szpilman
    Footnotes
    1 All authors are affiliated with the International Drowning Researchers’ Alliance (IDRA).
    Affiliations
    Medical Committee, International Life Saving Federation, Belgium

    Brazilian Lifesaving Society (SOBRASA), Barra da Tijuca, Rio de Janeiro, Brazil

    Drowning Resuscitation Centre, Fire Department of Rio de Janeiro (CBMERJ), Brazil
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  • Author Footnotes
    1 All authors are affiliated with the International Drowning Researchers’ Alliance (IDRA).

      Abstract

      Aim

      Despite an obstructed airway (choking) being a relatively preventable injury, it has a considerable mortality burden globally, with increasing incidence. Given new technologies in choking management, this systematic review aimed to assess current literature on the effectiveness of anti-choking suction devices at relieving obstructions.

      Methods

      Ovid MEDLINE, Embase, PubMed, The Cochrane Library, SCOPUS, Web of Science, CINAHL Plus and the English websites of the devices were searched on September 23, 2019. Studies were included if they reported the anti-choking devices’ dislodgment success rate (primary outcome) or associated adverse events (secondary outcome). Articles, conference abstracts or technical reports were included if peer reviewed. Certainty of evidence was assessed in accordance with GRADE.

      Results

      Five studies satisfied the inclusion criteria for this review. Two studies (40%) reported findings of a single centre mannequin trial, one (20%) of a single centre cadaveric trial, and two (40%) were case series. Cohen’s Kappa for the first and second round of screening was 0.904 and 0.674 respectively. Although several devices have been manufactured worldwide, the LifeVac© has been most extensively studied, with a combined dislodgement success rate of 94.3% on first attempt. However, certainty of evidence for the primary outcome was evaluated as very low.

      Conclusions

      There are many weaknesses in the available data and few unbiased trials that test the effectiveness of anti-choking suction devices resulting in insufficient evidence to support or discourage their use. Practitioners should continue to adhere to guidelines authored by local resuscitation authorities which align with ILCOR recommendations.

      Keywords

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      References

        • Fingerhut L.A.
        • Cox C.S.
        • Warner M.
        International comparative analysis of injury mortality. Findings from the ICE on injury statistics. International Collaborative Effort on Injury Statistics.
        Adv Data. 1998; 303: 1-20
        • Fridman L.
        • Fraser-Thomas J.
        • Pike I.
        • Macpherson A.K.
        An interprovincial comparison of unintentional childhood injury rates in Canada for the period 2006–2012.
        Can J Public Health. 2018; 109: 573-580
        • Kramarow E.
        • Chen L.H.
        • Hedegaard H.
        • Warner M.
        Deaths from unintentional injury among adults aged 65 and over: United States, 2000–2013.
        NCHS Data Brief. 2015; : 199
        • Committee on Injury, Violence and Poison Prevention
        Prevention of choking among children.
        Pediatrics. 2010; 125: 601-607
        • Perkins G.D.
        • Handley A.J.
        • Koster R.W.
        • et al.
        European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation.
        Resuscitation. 2015; 95: 88-99
        • Berg R.A.
        • Hemphill R.
        • Abella B.S.
        • et al.
        2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Case: part 5: adult basic life support.
        Circulation. 2010; 122: S685-S705
        • Heimlich H.J.
        A life-saving maneuver to prevent food choking.
        JAMA. 1975; 234: 398-401
        • Markel H.
        Health blog: how Dr. Heimlich got his maneuver 40 years ago. PBS news hour.
        2014 (Accessed 30 September 2019, at https://www.pbs.org/newshour/health/dr-heimlich-got-maneuver)
        • Soroudi A.
        • Shipp H.E.
        • Stepanski B.M.
        Adult foreign body airway obstruction in the prehospital setting.
        Prehosp Emerg Care. 2007; 11: 25-29
        • Redding J.S.
        The choking controversy: critique of evidence on the Heimlich maneuver.
        Crit Care Med. 1979; 7: 475-479
        • Vilke G.M.
        • Smith A.M.
        • Ray L.U.
        • Steen P.J.
        • Murrin P.A.
        • Chan T.C.
        Airway obstruction in children aged less than 5 years: the prehospital experience.
        Prehosp Emerg Care. 2004; 8: 196-199
        • Ingalls T.H.
        Heimlich versus a slap on the back.
        N Engl J Med. 1979; 300: 990
        • Heimlich H.J.
        • Hoffman K.A.
        • Canestri F.R.
        Food-choking and drowning deaths prevented by external subdiaphragmatic compression. Physiological basis.
        Ann Thorac Surg. 1975; 20: 188-195
        • Boussuges S.
        • Maitrerobert P.
        • Bost M.
        Use of the Heimlich Maneuver on children in the Rhone-Alpes area.
        Arch Fr Pediatr. 1985; 42: 733-736
        • Guildner C.W.
        • Williams D.
        • Subitch T.
        Airway obstructed by foreign material: the Heimlich maneuver.
        JACEP. 1976; 5: 675-677
        • Castro M.
        • Midthun D.E.
        • Edell E.S.
        • et al.
        Flexible bronchoscopic removal of foreign bodies from pediatric airways.
        J Bronchol. 1994; 1: 92
        • Couper K.
        • Abu Hassan A.
        • Ohri V.
        • et al.
        Foreign body airway obstruction in Adults and Children Consensus on Science with Treatment Recommendations.
        2020 (Accessed 13 January 2020, at https://costr.ilcor.org/document/removal-of-foreign-body-airway-obstruction-tfsr-costr)
        • Guyatt G.
        • Oxman A.D.
        • Akl E.A.
        • et al.
        GRADE Guidelines: 1. Introduction – GRADE evidence profiles and summary of findings tables.
        J Clin Epidemiol. 2011; 64: 383-394
      1. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011].
        in: Higgins J.P.T. Green S. The Cochrane Collaboration. 2011 (Accessed 5 September 2019, at www.handbook.cochrane.org)
        • Sterne J.A.C.
        • Hernán M.A.
        • Reeves B.C.
        • et al.
        ROBINS-I: a tool for assessing risk of bias in non-randomized studies of interventions.
        BMJ. 2016; 355
        • Murad M.H.
        • Sultan S.
        • Haffar S.
        • et al.
        Methodological quality and synthesis of case series and case reports.
        BMJ Evid Based Med. 2018; 23: 60-63
        • Lih-Brody L.
        • Lih A.
        • Brody E.
        • Singer M.
        LifeVac: a novel apparatus to resuscitate a choking victim.
        Am J Gastroenterol. 2015; 110: S695
        • Lih-Brody L.
        • Singer M.
        • Brody E.
        Lifevac: a novel apparatus for the resuscitation of the adolescent choking victim.
        Ann Emerg Med. 2017; 70: S149-S150
        • Juliano M.
        • Domingo R.
        • Mooney M.
        • Trupiano A.
        Assessment of the LifeVac, an anti-choking device, on a human cadaver with complete airway obstruction.
        Am J Emerg Med. 2016; 34: 1673-1674
        • Saperstein D.M.
        • Pugliesi P.R.
        • Ulteig C.
        • Schreiber N.
        Successful use of a novel device called the LifeVac to resuscitate choking victims - worldwide results.
        Int J Clin Exp Med. 2018; 12
        • Brody-Lih L.
        • Benenson A.
        • Chin R.
        Successful resuscitation of choking victims using a Lifevac, a non-powered portable suction device: real world experience. Program No. P1997.
        Proceedings of the World Congress of Gastroenterology at ACG. American College of Gastroenterology, Orlando, FL2015
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • PRISMA Group
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS Med. 2009; 6e1000097
      2. Brody EP, Lih-Brody L, Millspaugh M. LifeVac simulation study: a novel apparatus for the resuscitation of a choking victim. LifeVac Canada Inc. (n.d).

        • LifeVac Canada Inc
        LifeVac cadaver testing. Report. Fusions technologies.
        2015
      3. LifeVac Canada Inc. How it works. (Accessed 7 December 2019, at https://lifevac.ca/how-it-works/).

      4. LifeVac Europe LTD. FAQ. (Accessed 7 December 2019, at http://www.lifevac.eu/faq/).

      5. Dechoker. Dechoker FAQ. (Accessed 7 December 2019, at https://www.dechoker.com/pages/dechoker-faq).

      6. Smith M. Biased sample and extrapolation. Common mistakes in using statistics: spotting and avoiding them. (Accessed 8 December 2019, at https://web.ma.utexas.edu/users/mks/statmistakes/biasedsampling.html).