Glucagon is NOT Recommended for Foreign Body Obstruction in the Throat
Glucagon has no role in the management of foreign body airway obstruction and should not be used. The most recent international resuscitation guidelines do not mention glucagon as a treatment option for this emergency, and established protocols focus on mechanical removal techniques.
Recommended Management Algorithm
For Conscious Patients with Ineffective Cough:
Initial intervention should be back slaps (back blows), which generate high initial pressures that may dislodge objects from the larynx 1. This should be the first-line approach in adults and children with foreign body airway obstruction and an ineffective cough 1.
If back slaps fail, proceed immediately to abdominal thrusts (Heimlich maneuver) in adults and children over 1 year of age 1. The combination of maneuvers is preferable to any single technique, as back blows generate high initial pressures while thrust maneuvers generate more sustained increases in intrathoracic pressure 2.
For Unconscious Patients:
Chest thrusts should be used in unconscious adults and children with foreign body airway obstruction 1. If the patient becomes unconscious, immediately call emergency medical services and initiate chest compressions 3.
For Healthcare Providers:
Appropriately skilled healthcare providers should use Magill forceps to remove visible foreign body airway obstructions, particularly in patients with out-of-hospital cardiac arrest from foreign body obstruction 1.
Manual extraction of visible items in the mouth is appropriate, but blind finger sweeps should be avoided as they can cause harm including dislodgement of the object deeper into the airway and injury to the nasopharynx 1, 4.
Important Caveats
Suction-based airway clearance devices are not routinely recommended due to weak evidence and potential for harm 1.
Encourage coughing first if the patient has an effective cough, as this is a normal physiological response that may be effective and is unlikely to cause harm 1.
Bystanders should undertake interventions as soon as possible after recognition to prevent progression to cardiac arrest 1.
The evidence for all foreign body airway obstruction interventions is very low certainty, as randomized controlled trials would be unethical and impractical in this emergency situation 1. However, the consistent international consensus across multiple years (2020,2022,2023) strongly supports mechanical removal techniques without any mention of pharmacologic agents like glucagon 1.