Abstract
Background: It is unclear what on-site treatment is given to people suffering airway obstruction. This study attempted to clarify actual initial responses at the scene to patients suffering a foreign body airway obstruction witnessed by someone else.
Method: From January 2003 until December 2006 we interviewed bystanders and emergency workers involved with 50 patients who suffered an airway obstruction and were transported to our critical care centre. We asked them what the obstructing body was and what treatment had been given at the scene in order to examine their impact on the outcome. The patients were divided into two groups according to whether they survived or died. Within these groups they were examined according to: 1) age, 2) gender, 3) whether an effort was made to remove the foreign body after the patient became unresponsive, 4) presence/absence of bystander cardiopulmonary resuscitation (CPR), 5) time elapsed from the emergency call to scene, 6) time elapsed from the emergency call to emergency room (ER) admission, 7) variety of the foreign body (whether a solid mass or not), and 8) index of independence in activities of daily living (ADLs) regarding feeding (dependent/independent).
Results: In each of the 50 cases the patient was unresponsive when the emergency team arrived. Prior to loss of responsiveness, bystanders had not done anything to clear the foreign body from the airway. Once the patient became unresponsive, the sole action taken in 50% of cases was to remove the obstruction, while in 38% of cases it was to call an ambulance. External cardiac massage was performed in just 12% of cases. There was no significant difference between the survival group (n=16) and the group of patients dead at the point of hospital discharge after becoming comatose following foreign body airway obstruction (n=34). A significantly shorter time from the emergency call to ER arrival was observed in the survival group.
Conclusion: Prior to the patients' loss of responsiveness, the bystanders had not done anything to clear the foreign body from the airway. Only 12% of patients unresponsive after airway obstruction received CPR. Recently, educational programs for basic life support (BLS) have been conducted on several occasions in the area. It is possible that there is a lower prevalence of BLS programs for lay rescuers or health care providers that include training for life-threatening conditions such as airway obstruction. It is therefore important to record the prevalence of BLS programs that include such life-threatening scenarios and further educational movement required to improve patient outcome by examining the initial response to patients who suffered a foreign body airway obstruction witnessed by a third party.
