From the Guidelines
Emergency department physicians should primarily use a combination of back blows and chest thrusts to clear foreign body airway obstructions (FBAO) in infants, as recommended by the American Heart Association guidelines 1. Neither fishing around with a glidescope and McGill forceps nor intentionally pushing the obstruction into one lung is recommended as a first-line approach. For an infant with FBAO, the physician should deliver five back blows between the shoulder blades with the infant held prone over the provider's forearm, followed by five chest thrusts if the obstruction persists, as outlined in the guidelines 1. This sequence should be repeated until the object is expelled or the infant becomes unconscious. If the infant becomes unconscious, CPR should be initiated, and direct laryngoscopy may be attempted to visualize and remove the foreign body, but blind finger sweeps should be avoided as they may push the object further into the airway 1. Using instruments like a glidescope and McGill forceps should only be considered when the object is clearly visualized and can be safely grasped. Deliberately pushing an obstruction into one lung is generally not recommended as it can cause complications like pneumonia, atelectasis, or lung abscess, though in rare emergency situations where the object cannot be removed and the patient cannot be ventilated, this may be considered as a last resort to allow ventilation through the unobstructed lung until definitive management can be provided. Some key points to consider when managing FBAO in infants include:
- The importance of acting quickly to relieve the obstruction if it is severe
- The need to avoid interfering with mild obstructions, allowing the infant to clear the airway by coughing
- The potential risks of using instruments like glidescope and McGill forceps, and the importance of only using them when the object is clearly visualized and can be safely grasped 1.
From the Research
Methods for Clearing FBAO Obstruction in Infants
- The use of back blows, abdominal thrusts, and chest thrusts/compressions are common interventions for relieving foreign body airway obstructions (FBAO) in infants 2, 3.
- Magill forceps and manual removal of obstructions from the mouth are also effective in relieving FBAO 2.
- Suction-based airway clearance devices may also be used to clear FBAO obstruction in infants 2.
- In some cases, a combination of maneuvers may be preferable to any single maneuver 3.
Comparison of Techniques
- There is limited data on the effectiveness of different techniques for clearing FBAO obstruction in infants 3, 4.
- One study found that abdominal thrusts and chest compressions were associated with decreased odds of FBAO relief compared to back blows as the first intervention 4.
- Another study suggested that a combination of back blows and thrust maneuvers may be effective in dislodging objects from the larynx 3.
Use of Glidescope and McGills
- There is no direct evidence on the use of glidescope and McGills for clearing FBAO obstruction in infants in the provided studies.
- However, the use of Magill forceps, which are similar to McGills, has been shown to be effective in relieving FBAO 2.
Pushing the Obstruction into One Lung
- There is no direct evidence on the effectiveness of pushing the obstruction into one lung as a technique for clearing FBAO obstruction in infants in the provided studies.
- However, one study suggested that maintaining an open airway through mouth-to-mouth and/or nose aspiration, spitting out secretions, may be a simple method for recovering a foreign body causing a complete airway obstruction in extreme circumstances 5.