Adult foreign body airway obstruction in the prehospital setting

Background. Although the treatment of foreign body airway obstruction in adults has been well studied, few data exist on the characterization of prehospital experiences. Objectives. To describe the frequency, etiologies, and treatments of foreign body airway obstruction in adults in the prehospital setting and to discuss the relative efficacies of treatments and presenting factors that predict overall patient outcome. Methods. A San Diego County prehospital database was retrospectively reviewed for all adult patients over a 17-month period with data extracted on demographic characteristics, incident outcome, patient disposition, item involved in obstruction, location of episode, initial vital signs, initial level of consciousness, pertinent medical history, treatments initiated by bystanders and paramedics, and response to those treatments. Results. During the study period, there were 513 cases of foreign body airway obstruction in adults. Of these, 17 (3.3%) died. The mean age was 65.0 years, with increasing age correlating with worse outcome. The item causing obstruction varied widely, with medications and meat being the most common items. The Heimlich maneuver was the most commonly used intervention, with an 86.5% rate of patient improvement. Magill forceps proved useful for three cases refractory to the Heimlich maneuver. Presenting vital sign aberrations, particularly with respiratory rate, correlated with poorer patient outcome. Conclusions. Foreign body airway obstruction represents a true emergency in adults, with a 3.3% mortality rate in the current study. The Heimlich maneuver was used frequently and with good success.