Choking, the 4th leading cause of accidental death worldwide, prompts an exploration of anti-choking devices in first aid. This article considers their role and effectiveness. Considering the availability of anti-choking suction devices, ought we to have them at home and in the workplace?
Victims of a Foreign Body Airway Obstruction (FBAO) may suffer irreversible brain damage or death within minutes. Brain cells may begin to die off in just 2-3 minutes and irreversible brain damage may occur in just 5. By 8-10 minutes, death becomes likely. Specifically, timelines vary from person to person. However, the principle is clear: the sooner the airway can be unobstructed, the better. Established first aid techniques aim to dislodge the obstruction using two different methods in repeated succession (“5+5”: five back blows followed by five abdominal thrusts). Should the patient become unconscious, CPR may free the airway. However, despite our best efforts, not every person can be saved using these first aid techniques. Might anti-choking suction devices succeed where existing techniques have met their match?
There are two devices currently on the market. LifeVac, a plunger with a one-way valve, and Dechoker, utilizing negative pressure from a vacuum syringe. Both have been on the market since 2015. LifeVac says its device creates a suction force three times that of the most forceful cough. Impressively, both devices purport to have saved hundreds of lives globally, with no reported adverse effects under the scrutiny of the UK’s MHRA (Medicines and Healthcare products Regulatory Agency). However, it is not clear how many have actually been bought, sold and used here in the UK. Portable and requiring no power, they seem like an interesting, even exciting, prospect. As evidence about them accrues, might they offer a shift in the landscape of First Aid?
There are several possible advantages, the first is that they have the potential to be used in conjunction with existing techniques, should the cycles of back blows and abdominal thrusts fail. The suction devices could also be particularly suitable for scenarios where conventional methods may be challenging, e.g. bariatric patients, individuals in wheelchairs or those too frail for standard techniques. In addition, perhaps they could be helpful when there is no bystander, alongside self-administered abdominal thrusts? Self-rescue presents a particular challenge as it is not possible to deliver self-rescue back blows.
Despite their promise, the Resuscitation Council here in the UK and ILCOR (International Liaison Committee on Resuscitation) currently do not recommend suction-based anti-choking devices. At the last ILCOR conference, their review found a lack of independent evidence, noting that much relied on case reports and limited trials, mainly on manikins. Concerns were raised that if the devices were not effective, precious time could be lost to use other techniques or get professional help.
One limitation is that, for sanitary reasons, they cannot be reused, though the LifeVac device (currently £73.54), comes with a promise to replace any used devices free of charge.
Serious concerns emerged from a small 2023 study that tested both the LifeVac and the Dechoker. The trial involved repeated attempts to remove three items – namely saltine crackers, whole grapes and cashews – from vocal cord depth of one fresh cadaver. Alarmingly, neither device successfully removed the grapes or cashews. While LifeVac succeeded with the saltine crackers, the Dechoker did not succeed in any endeavour. In addition, both devices caused serious injury to the tongue which would have resulted in inflammation – possibly to the oesophagus – and bleeding.
Upon entering the UK market and its much stricter regulations, LifeVac and Dechoker initially restricted their sales to advanced medical practitioners or to those supporting someone in a moulded wheelchair. Their devices were not promoted towards children. As of June 2023, these restrictions have eased and studies are ongoing to build evidence. Future ILCOR conferences may reconsider recommendations based on accumulating evidence, potentially integrating these devices into high-risk settings. For this to succeed, they will need to address the very serious concerns of the 2023 cadaver study.
While anti-choking devices appear to present an intriguing prospect as first aid tools, caution is warranted. Emphatically, the small 2023 study raises serious doubts about their effectiveness, which have not yet been addressed. However, it is not conclusive in itself due to its small size and the use of just one cadaver. Reviews of further independent studies – especially on cadavers rather than manikins – will be an opportunity to fully weigh up the evidence. With this in mind, we will not yet be adding anti-choking devices to our first aid training courses and we cannot recommend their use at home, school or work.
With anti-choking devices not currently recommended, first aid advice remains unchanged. Here are the critical steps:
- Call for emergency medical assistance immediately. In the UK, this is 999 or 112.
- Assess the situation, perform five back blows and five abdominal thrusts (chest thrusts for infants) in repetition, checking each time to see if the object has been ejected.
- If the person becomes unconscious, perform CPR, checking first to see if the object can be removed. Remove visible obstructions cautiously.
- Patients should be medically evaluated after treatment for any potential harm caused.
Please see here for more guidelines on Choking from the Resuscitation Council.
Groups more likely to choke include: children, adults over 65, individuals with various health conditions, and those with swallowing difficulties.