What is the evidence that anti-choking (obstruction relief) devices are effective?

Evidence for Anti-Choking Devices: Limited Support for Efficacy and Safety

The current evidence does not support the routine use of suction-based airway clearance devices for foreign body airway obstruction (FBAO), and traditional methods like back slaps and abdominal thrusts remain the recommended first-line interventions. 1

Current Guideline Recommendations for FBAO Management

First-Line Interventions

• Back slaps should be used initially in adults and children with FBAO and ineffective cough (weak recommendation, very low-certainty evidence) 1
• Abdominal thrusts should be used when back slaps are ineffective (weak recommendation, very low-certainty evidence) 1
• Chest thrusts should be used in unconscious adults and children with FBAO 1

Additional Interventions

• Manual extraction of visible items in the mouth may be considered 1
• Blind finger sweeps are NOT recommended due to potential harm 1
• Healthcare providers with appropriate skills may use Magill forceps to remove FBAO in cardiac arrest patients 1

Evidence on Suction-Based Anti-Choking Devices

Current Guideline Position

The 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science explicitly states: "We suggest against the routine use of suction-based airway clearance devices" (weak recommendation, very low-certainty evidence) 1

Rationale for This Position

• The peer-reviewed literature assessing suction-based airway clearance devices comprised just one case series of 9 adults, deemed insufficient to support implementation of a new technology with associated financial and training costs 1

Emerging Research on Anti-Choking Devices

While not included in current guidelines, some recent studies report:

1. A case series of 38 out of 39 successful resuscitations using the LifeVac device in patients with oropharyngeal dysphagia during choking emergencies 2

2. A retrospective analysis of 124 LifeVac and 61 Dechoker interventions reporting resolution of choking symptoms in 123 and 60 cases respectively, with only three adverse events (1.6%) reported 3

3. A mixed-methods case study of 27 choking incidents where the Dechoker device reportedly removed the obstruction in 26 cases 4

Important Considerations and Limitations

Effectiveness of Traditional Methods

• Choking events are commonly witnessed, and when traditional interventions are promptly applied, survival rates can exceed 95% 1
• Traditional techniques (back blows, abdominal thrusts, chest thrusts) have documented success in relieving FBAO in conscious victims 1

Quality of Evidence

• Evidence for both traditional techniques and anti-choking devices is rated as very low-certainty 1
• Most studies on anti-choking devices are:
  • Retrospective
  • Self-reported
  • Manufacturer-associated
  • Lacking control groups
  • Subject to reporting bias

Safety Concerns

• Traditional techniques have documented complications:

  • Abdominal thrusts: gastric/esophageal injuries, vascular injuries, thoracic injuries 1
  • Back blows: vascular injuries, thoracic injury 1
  • Finger sweeps: dislodgement of object deeper, injury to nasopharynx 1

• Anti-choking devices have limited safety data, though reported complications include:

  • Device malfunction (disconnection of parts)
  • Lip laceration
  • Tooth avulsion 3

Practical Approach to Choking Management

1. Recognize severe airway obstruction - signs include silent cough, cyanosis, inability to speak or breathe, universal choking sign 1

2. Apply traditional techniques in sequence:

   • Begin with back slaps
   • Progress to abdominal thrusts if back slaps ineffective
   • Use chest thrusts for unconscious victims or when other methods fail 1

3. Consider anti-choking devices only when:

   • Traditional methods have failed
   • The patient has anatomical or medical conditions that make traditional techniques difficult or contraindicated
   • Understanding that these devices are not currently recommended in guidelines due to insufficient evidence 1

Research Gaps

Researchers have identified significant knowledge gaps regarding anti-choking devices:

• Need for prospective, controlled studies independent of manufacturers 5
• Better understanding of which patient populations might benefit most 3
• Comparative effectiveness studies against traditional techniques 5
• Long-term safety data 5

Until more robust evidence emerges, healthcare providers should continue to follow established guidelines for FBAO management, with traditional techniques remaining the standard of care.