Written by Michael Stocker
Spoon Feed
Back blows outperformed abdominal thrusts and chest compressions in successful clearance of out-of-hospital foreign body airway obstructions (FBAO).
Heimlich maneuver chokes in primetime
This observational cohort study compared the efficacy of basic life support (BLS) methods for FBAO – abdominal thrusts, back blows, and chest compressions. 709 all-ages cases of FBAO requiring intervention were included, with the primary outcome of FBAO relief and secondary outcomes of survival to discharge and intervention-associated injuries. The plurality of patients were over 65 years old (n=260), and the next largest age group was 1 year or less (n=191). Performed in Canada, researchers utilized patients’ healthcare identification number to link prehospital, emergency department, and hospital data. In all-comers, odds of FBAO relief were better for back blows when compared with abdominal thrusts (aOR 0.55, 95%CI 0.38-0.80) and chest compressions (aOR 0.11, 95%CI 0.11-0.38). There was no difference in odds of survival to discharge between back blows and abdominal thrusts, though chest compressions underperformed (aOR 0.16, 95%CI 0.05-0.55). 10 intervention-associated injuries were identified, most of which were associated with chest compressions, and none attributed to back blows. Notably, patients who received their first intervention from a paramedic as opposed to a bystander accounted for a significantly greater proportion of deaths (23% vs 13%, p<0.001)…meaning, bystander intervention saves lives!
How will this change my practice?
Back blows will be first line for me should I be a bystander in a FBAO situation and when educating first responders. I hope this study stimulates more research on a topic that is otherwise light on high quality evidence. Patients do better if bystanders intervene before EMS arrives – so, keep pushing BLS education in your community.
Editor’s note:
I learned BLS using the AHA curriculum, which teaches back blows followed by chest compressions in infant choking and only abdominal thrusts in others over 1 year of age. Turns out, the American Red Cross, British Red Cross, ILCOR, and ERC all recommend back blows first in any conscious choking victim, followed by abdominal thrusts (in those over 1 year old) if unsuccessful.
The technique is to lean the patient forward on your non-dominant arm and strike the back between the scapulae 5 times very firmly with the heel of the hand (palmar/thenar/hypothenar area), similar to how it’s done in infants, just a good bit harder in a larger child, adolescent, or adult. If unsuccessful, then move to the Heimlich maneuver and perform 5 abdominal thrusts. See this British Red Cross video. ~Clay Smith
Source
Evaluation of basic life support interventions for foreign body airway obstructions: A population-based cohort study. Resuscitation. 2024 Aug;201:110258. doi: 10.1016/j.resuscitation.2024.110258. Epub 2024 May 31. PMID: 38825222
Editorial: Long-awaited evidence on back blows versus abdominal thrusts. Resuscitation. 2024 Aug;201:110299. doi: 10.1016/j.resuscitation.2024.110299. Epub 2024 Jul 2. PMID: 38964448.
Another Spoonful
I’m sorry, but I just have to share this. I asked ChatGPT to draw a picture of a single rescuer giving a responsive adult choking victim back blows. This is what I got. The rescuer is CHOKING the guy! So much for AI taking over the world… ~Clay
