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[Use of the Heimlich Maneuver on children in the Rhône-Alpes area]
Abstract
In 27 children suffering from a foreign body in the respiratory tract with asphyxia, the Heimlich manoeuvre, previously described, was successful in saving life of this dramatic situation in all cases, without respiratory complication. While this method is better known by members of first-aid associations than by pediatricians, it may be successfully used in very young children and infants.
... Relaxant anesthesia is better than spontaneous or inhalation agents, as it prevents dislodgement at the glottis, provides better exposure of the glottis. 7 Technique of bronchoscopic removal is visualization of larynx with Macintosh laryngoscope, inspection, extraction and check bronchoscopy. While extracting the foreign body from the glottis precaution must be taken as it is the commonest site for dislodgement. ...
p class="abstract">Aspiration of foreign bodies by children is a common problem around the world. Foreign body aspiration is a common cause of morbidity and mortality in children, especially between ages 18 months to 3 years. Laryngeal foreign bodies pose as a dire emergency lead to choking and accidental deaths. This is a case series of five cases of laryngeal foreign bodies presenting as a dire emergency to our casualty. Detailed history and examination was done. Radiological investigations were done. Rigid bronchoscopy was performed and the foreign body was extracted restoring the airway, preventing the accidental death of the patient. Foreign bodies of the airway are the most common causes of preventable deaths among children. Quick detailed history, examination and radiological investigations are required to come to the diagnosis and prompt management. This case series throws light on how to manage laryngeal foreign bodies.</p
... 6,7 There is some anecdotal and retrospective evidence to support these recommendations. [11][12][13][14][15][16][17] One review of a prehospital database studied obstructed airway injuries that Emergency Medical Services (EMS) responded to. In that study, 50% of the obstructions were relieved before the paramedic services arrived and intervention by EMS with abdominal thrusts increased the success rate to greater than 85%. ...
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.
... [5] The Heimlich maneuver proved to be useful in cases without any respiratory complication. [7] A case report who aspirated a throat lozenge that had been in his mouth resulted in a complete airway obstruction resolved by back blows alone. [8] The flow of fast-moving air column can exert pressure over the surface of a lodged FB leading to its expulsion. ...
... It is unclear which method of removal of FBAO should be used first. For conscious victims, case reports showed success in relieving FBAO with back blows (LOE 5), [35][36][37] abdominal thrusts (LOE 5), [36][37][38][39][40][41][42][43][44] and chest thrusts (LOE 5). 36 Frequently, more than one technique was needed to achieve relief of the obstruction. ...
International Liaison Committee on Resuscitation
Consensus Development Conference
Ireland
Resuscitation
Resuscitation. 2005 Nov-Dec;67(2-3):187-201.
... Case series and case reports have documented successful relief of FBAO in conscious victims with the use of back blows (LOE 4 161,162 ), abdominal thrusts (LOE 4 [161][162][163][164][165], and chest thrusts (LOE 4 161 ; LOE 5 166 ). More than 1 technique was occasionally required to relieve the obstruction. ...
This 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science With Treatment Recommendations on basic life support summarizes evidence evaluations performed for 22 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 5 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review.
Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest.
The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.
This 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science With Treatment Recommendations on basic life support summarizes evidence evaluations performed for 20 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 3 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review.
Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest.
The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.
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.
The critical lifesaving steps of BLS are ● Immediate Recognition and Activation of the emergency response system ● Early CPR and ● Rapid Defibrillation for VF. When an adult suddenly collapses, whoever is nearby should activate the emergency system and begin chest compressions (regardless of training). Trained lay rescuers who are able and healthcare providers should provide compressions and ventilations. Contrary to the belief of too many in this situation, CPR is not harmful. Inaction is harmful and CPR can be lifesaving. However, the quality of CPR is critical. Chest compressions should be delivered by pushing hard and fast in the center of the chest (ie, chest compressions should be of adequate rate and depth). Rescuers should allow complete chest recoil after each compression and minimize interruptions in chest compressions. They should also avoid excessive ventilation. If and when available, an AED should be applied and used without delaying chest compressions. With prompt and effective provision of these actions, lives are saved every day.
Basic life support (BLS) is the foundation for saving lives following cardiac arrest. Fundamental aspects of BLS include immediate recognition of sudden cardiac arrest (SCA) and activation of the emergency response system, early cardiopulmonary resuscitation ( CPR ), and rapid defibrillation with an automated external defibrillator ( AED) . Initial recognition and response to heart attack and stroke are also considered part of BLS. This section presents the 2010 adult BLS guidelines for lay rescuers and healthcare providers. Key changes and continued points of emphasis from the 2005 BLS Guidelines include the following:
Despite important advances in prevention, SCA continues to be a leading cause of death in many parts of the world.1 SCA has many etiologies (ie, cardiac or noncardiac causes), circumstances (eg, witnessed or unwitnessed), and settings (eg, out-of-hospital or in-hospital). This heterogeneity suggests that a single …
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