Is glucagon used for relief of choking?

From the Guidelines

Glucagon is not recommended for treating choking emergencies. The standard approach for choking remains the Heimlich maneuver (abdominal thrusts) for conscious victims or CPR with airway checks for unconscious victims. While glucagon has been historically considered as a potential intervention because it can relax smooth muscle, including the lower esophageal sphincter, there is insufficient evidence supporting its effectiveness for foreign body airway obstruction, as seen in a study on prevention of choking among children 1.

Some key points to consider in choking emergencies include:

• The most common objects on which children choke are food, coins, balloons, and other toys, highlighting the need for prompt and effective intervention 1
• Choking is a leading cause of morbidity and mortality among children, especially those who are 3 years of age or younger, due to developmental vulnerabilities of a young child’s airway and the underdeveloped ability to chew and swallow food 1
• The use of glucagon in choking emergencies is not supported by evidence, and its potential side effects, such as nausea and vomiting, might worsen the situation
• Emergency services should be called immediately for choking emergencies, and rescuers should follow established protocols of back blows and abdominal thrusts, which have proven effectiveness in dislodging airway obstructions.

In real-life clinical medicine, the priority is to act quickly and effectively to prevent oxygen deprivation, which can cause brain damage within 4-6 minutes, making the Heimlich maneuver and CPR with airway checks the preferred interventions over glucagon.

From the FDA Drug Label

Turn the person on their side. When an unconscious person awakens, they may vomit. Turning the person on their side will lessen the chance of choking. After giving Glucagon for Injection the caregiver should call for emergency medical help right away. Turn the person on their side to prevent them from choking

Glucagon is used to treat very low blood sugar (severe hypoglycemia) in people with diabetes mellitus. When administering Glucagon to an unconscious person, it is recommended to turn them on their side to prevent choking in case they vomit when they awaken. This is a precautionary measure to ensure the person's airway is protected. [2] [3] 4

From the Research

Choking Relief Methods

• The Heimlich maneuver is a widely recognized technique for relieving choking caused by foreign body airway obstruction 5, 6, 7, 8.
• The maneuver involves intentional compression thrusts to the abdomen, which can expel air from the lungs and dislodge the entrapped food or other material 5.
• The table maneuver is another technique that has been used successfully in relieving foreign-body airway obstruction in unconscious elderly patients 9.
• This technique involves laying the patient down on a table in a prone position and giving sharp blows between the scapulas with the heel of the hand 9.

Effectiveness of Choking Relief Methods

• The Heimlich maneuver has been found to be successful as an emergency adjunct measure in removing food blocking the airway 5.
• The table maneuver has been shown to be a potentially life-saving technique that could be applied to patients with severe choking caused by foreign-body airway obstruction who fail to respond to the Heimlich maneuver and other conventional treatments 9.
• The effectiveness of the Heimlich maneuver can be influenced by the angle at which thrusts are performed and the body position of the patient 7, 8.
• Self-administered abdominal thrusts and chair thrusts can produce similar pressures to those performed by another person, and may be useful in certain situations 7.

Glucagon for Choking

• There is no evidence in the provided studies to suggest that glucagon is used as a treatment for choking 5, 9, 6, 7, 8.
• The studies focus on physical maneuvers such as the Heimlich maneuver and the table maneuver, rather than pharmacological interventions like glucagon.