 |
| El Consejo Español de Resucitación Cardiopulmonar CERCP NO RECOMIENDA DISPOSITIVOS para OBSTRUCCIÓN DE VIAS AEREAS
💥💥💥 Comunicado del CERCP acerca de los nuevos dispositivos publicitados para la desobstrucción de la vía aérea.💥💥💥
⚠⚠⚠ CONCLUSIONES ⚠⚠⚠
❤ Tras analizar la escasa bibliografía médica disponible en la actualidad, acerca de la indicación y seguridad de uso de estos dispositivos en los atragantamientos y teniendo en cuenta las altas presiones de succión que se han detectado, que podrían ser dañinas para el paciente, especialmente para el niño, el CERCP recomienda seguir actuando ante los atragantamientos tal y como indican las recomendaciones internacionales mediante la tos, golpes en la espalda y compresiones abdominales.
🧡 Es necesario disponer en el futuro de más estudios para poder concluir que el uso de estos dispositivos es eficaz y seguro para los pacientes y que sea incorporado a las Guías internacionales como un método para utilizar en los atragantamientos.Leer enlaces y fuentes al dia 14.09.2022 2020 *****A.T.E.N.C.I.Ó.N.***** NO RECOMENDADO a fecha 14.09.2022 por ILCOR ERC-AHA-CONSEJO ESPAÑOL DE RCP. Eliminación de la obstrucción de la vía aérea por cuerpo extraño (BLS 368): revisión sistemática El grupo de trabajo reconoce la importancia de la eliminación temprana de FBAO para prevenir un paro cardíaco. leer Comunicado del CERCP acerca de los nuevos dispositivos publicitados para la desobstrucción de la vía aérea. |
La maniobra de Heimlich, o compresión abdominal, es una técnica de primeros auxilios usada para tratar el asfixia causada por obstrucciones de las vías respiratorias aéreas. Aquí hay una breve descripción:
1. **Evaluación**: comprueba si la persona puede toser o hablar. Si él no puede hacerlo, significa que las aerolíneas están completamente bloqueadas.
2. **Posicionamiento**: posicionamiento detrás de la persona que se ahoga.
3. **Preparación**: Envolver tus brazos alrededor de la cintura de uno.
4. **Acción**: Cierra una mano con un puño y colócala sobre el ombligo, pero debajo del esternón. Agarra un puño con la otra mano.
5. **Compresión**: Realiza compresiones internas y ascendentes rápidas, como si quisieras levantar a la persona.
6. **Repetición**: Continuar las compresiones hasta que la obstrucción sea expulsada o la persona pierda el conocimiento. Si pierde el conocimiento, inicie RCP (RCP) y llame a emergencia inmediatamente.
Esta técnica aprovecha la presión interna generada para sacar el objeto que bloquea las vías respiratorias.
1. **Evaluación**: comprueba si la persona puede toser o hablar. Si él no puede hacerlo, significa que las aerolíneas están completamente bloqueadas.
2. **Posicionamiento**: posicionamiento detrás de la persona que se ahoga.
3. **Preparación**: Envolver tus brazos alrededor de la cintura de uno.
4. **Acción**: Cierra una mano con un puño y colócala sobre el ombligo, pero debajo del esternón. Agarra un puño con la otra mano.
5. **Compresión**: Realiza compresiones internas y ascendentes rápidas, como si quisieras levantar a la persona.
6. **Repetición**: Continuar las compresiones hasta que la obstrucción sea expulsada o la persona pierda el conocimiento. Si pierde el conocimiento, inicie RCP (RCP) y llame a emergencia inmediatamente.
Esta técnica aprovecha la presión interna generada para sacar el objeto que bloquea las vías respiratorias.
Esto es lo que recomienda el ILCOR al dia 10 de enero del 2020
Recomendaciones de tratamiento
Sugerimos que los golpes de espalda se usen inicialmente en pacientes con OVACE y en tos ineficaz (recomendación débil, certeza de evidencia muy baja).
Sugerimos que los empujes abdominales se usen en adultos y niños con un OVACE y en tos ineficaz donde los golpes de espalda son ineficaces (recomendación débil, muy baja certeza de evidencia).
Sugerimos que los rescatistas consideren la extracción manual de elementos visibles en la boca (recomendación débil, certeza de evidencia muy baja).
Sugerimos evitar el uso de barridos con los dedos a ciegas en pacientes con OVACE (recomendación débil, muy baja certeza de evidencia).
Sugerimos que las personas debidamente capacitadas consideren el uso de pinzas Magill para eliminar OVACE (recomendación débil, certeza de evidencia muy baja).
Sugerimos que las compresiones torácicas se usen en pacientes inconscientes con un OVACE (recomendación débil, certeza de evidencia muy baja).
Sugerimos que los espectadores realicen intervenciones para apoyar la eliminación de OVACE tan pronto como sea posible después de ser identificada (recomendación débil, muy baja certeza de la evidencia).
Attachments
Evidence-to-Decision Table:
This Review is a draft version prepared by ILCOR, with the purpose to allow the public to comment and is labeled “Draft for Public Comment". The comments will be considered by ILCOR. The next version will be labelled “draft" to comply with copyright rules of journals. The final Review will be published on this website once a summary article has been published in a scientific Journal and labeled as “final”.
Conflict of Interest Declaration
The ILCOR Continuous Evidence Evaluation process is guided by a rigorous ILCOR Conflict of Interest policy. The following Task Force members and other authors were recused from the discussion as they declared a conflict of interest: none applicable
The following Task Force members and other authors declared an intellectual conflict of interest and this was acknowledged and managed by the Task Force Chairs and Conflict of Interest committees: none applicable
CoSTR Citation
Couper K, Abu Hassan A, Ohri V, Patterson E, Tang HT, Bingham B, Perkins GD, Avis S, Brooks S, Castren M, Chung C, Considine J, Kudenchuck P, Nishiyama C, Ristagno G, Semeraro F, Smith C, Smyth M Morley P, Olasveengen TM - on behalf of the International Liaison Committee on Resuscitation Basic and Paediatric Life Support Task Forces. Foreign body airway obstruction in Adults and Children Consensus on Science with Treatment Recommendations [Internet] Brussels, Belgium: International Liaison Committee on Resuscitation (ILCOR) Basic Life Support Task Force, 2020 Jan 1. Available from: http://ilcor.org
Methodological Preamble
The continuous evidence evaluation process for the production of Consensus on Science with Treatment Recommendations (CoSTR) started with a systematic review of basic life support (Couper, 2019, PROSPERO 2019 CRD42019154784) conducted by Keith Couper and Gavin Perkins with involvement of clinical content experts. Evidence for adult and paediatric literature was sought and considered by the Basic Life Support Adult Task Force and the Pediatric Task Force groups respectively. These data were taken into account when formulating the Treatment Recommendations.
PICOST
The PICOST (Population, Intervention, Comparator, Outcome, Study Designs and Timeframe)
Population: Adults and children with foreign body airway obstruction in any setting.
Intervention: Interventions to remove foreign body airway obstruction, such as finger sweep, back slaps, abdominal thrusts, chest thrusts, and suction-based airway clearance devices.
Comparators: No action.
Outcomes: Survival with good neurological outcome, survival, return of spontaneous circulation, relief of airway obstruction, harms/ complications.
Study Designs: Randomized controlled trials (RCTs) and non-randomized studies (non-randomized controlled trials, interrupted time series, controlled before-and-after studies, cohort studies), case series (≥5 cases) are eligible for inclusion. Case reports of injuries/ complications will be eligible.
Timeframe: All years and all languages were included as long as there was an English abstract. Unpublished studies (e.g., conference abstracts, trial protocols), animal studies, manikin studies, cadaver studies were excluded. Literature searched to September, 2019.
PROSPERO Registration CRD42019154784
In most cases bias was assessed per comparison rather than per outcome, since there were no meaningful differences in bias across outcomes. In cases where differences in risk of bias existed between outcomes this was noted.
Consensus on Science
Back blows
For the critical outcome of survival (n=1 study, Vilke 2004 196), important outcome of relief of foreign body airway obstruction (FBAO) (n=3 studies, Igarashi 2017 1396; Redding 1979 475; Vilke 2004 196) and important outcome of injuries/ complications (n=4 studies, Guinane 2018 1272; Nowitz 1998 129; Patterson 1993 741; Rakotoharinrasana 2003 43), we identified only observational studies. The overall quality of evidence was rated as very low for all outcomes primarily due to a very serious risk of bias. The individual studies were all at very serious risk of bias due to confounding. Because of this and a high degree of heterogeneity, no meta-analyses could be performed and individual studies are difficult to interpret.
For the critical outcome of survival, we identified very-low-certainty of evidence downgraded for very serious risk of bias and serious indirectness from one case series study (Vilke 2004 196) which reported survival in 13 patients treated with back blows.
For the important outcome of relief of FBAO, we identified very-low-certainty of evidence downgraded for very serious risk of bias and serious indirectness from three case series studies (Igarashi 2017 1396; Redding 1979 475; Vilke 2004 196) which reported relief of FBAO in 75 patients treated with back blows.
For the important outcome of injuries/ complications, we identified very low certainty evidence downgraded for very serious risk of bias from four studies (Guinane 2018 1272; Nowitz 1998 129; Patterson 1993 741; Rakotoharinrasana 2003 43) that reported four case reports of injuries/ complications in patients treated with back blows.
Abdominal thrusts
For the critical outcome of survival (n=2 studies, Boussuges 1985 733; Heimlich 1975 398), important outcome of relief of foreign body airway obstruction (FBAO) (n=6, Boussuges 1985 733; Heimlich 1975 398; Igarashi 2017 1396; Redding 1979 475; Soroudi 2007 25; Vilke 2004 196) and important outcome of injuries/ complications (n=49, Agia 1979 473; Ayerdi 2002 154; Bintz 1996 159; Bouayed 2015 427320; Caro Aguilera 2008 533; Cecchetto 2011 169; Chao 2012 e7; Chapman 1983 446; Chillag 2010 147; Cowan 1987 121; Croom 1983 2602; Desai 2008 1325; Dupre 1993 611; Entel 1996 251; Fearing 2002 978; Feeney 2007 252; Fink 1989 486;Haynes 1984 507; Herman 2018 e13; Kirshner 1985 594; Koss 2018 E1; Kosser 2009 1089; Lee 2019 210; Lee 2009 E34; Lette 1990 512; Lin 2003 380; Mack 2002 130; Majumdar 1998 609; Martin 2007 1146; Matharoo 2013 502; Meredith 1986 106; Nowitz 1998 129; Olenchock 2004 302; Otero Palleiro 2007 825; Passik 1987 469; Rakotoharinrasana 2003 43; Razaboni 1986 95; Roehm 1983 1186; Sams 1989 980; Skulberg 1992 91; Tashtoush 2015 275497; Truong 2018 48; Tung 2001 109; Ujjin 1984 175; Ulger 2016 15; Valero 1986 105; Van der Ham 1990 713; Visintine 1975 415; Wolf 2001 65-67), we identified only observational studies. The overall quality of evidence was rated as very low for all outcomes primarily due to a very serious risk of bias. The individual studies were all at very serious risk of bias due to confounding. Because of this and a high degree of heterogeneity, no meta-analyses could be performed and individual studies are difficult to interpret.
For the critical outcome of survival, we identified very low certainty of evidence downgraded for very serious risk of bias from two case series studies (Boussuges 1985 733; Heimlich 1975 398) which reported survival in 189 patients treated with abdominal thrusts.
For the important outcome of relief of FBAO, we identified very low certainty of evidence downgraded for very serious risk of bias from six case series studies (Boussuges 1985 733; Heimlich 1975 398; Igarashi 2017 1396; Redding 1979 475; Soroudi 2007 25; Vilke 2004 196) which reported relief of FBAO in 417 patients treated with abdominal thrusts.
For the important outcome of injuries/ complications, we identified very low certainty evidence downgraded for very serious risk of bias from 49 studies (Agia 1979 473; Ayerdi 2002 154; Bintz 1996 159; Bouayed 2015 427320; Caro Aguilera 2008 533; Cecchetto 2011 169; Chao 2012 e7; Chapman 1983 446; Chillag 2010 147; Cowan 1987 121; Croom 1983 2602; Desai 2008 1325; Dupre 1993 611; Entel 1996 251; Fearing 2002 978; Feeney 2007 252; Fink 1989 486;Haynes 1984 507; Herman 2018 e13; Kirshner 1985 594; Koss 2018 E1; Kosser 2009 1089; Lee 2019 210; Lee 2009 E34; Lette 1990 512; Lin 2003 380; Mack 2002 130; Majumdar 1998 609; Martin 2007 1146; Matharoo 2013 502; Meredith 1986 106; Nowitz 1998 129; Olenchock 2004 302; Otero Palleiro 2007 825; Passik 1987 469; Rakotoharinrasana 2003 43; Razaboni 1986 95; Roehm 1983 1186; Sams 1989 980; Skulberg 1992 91; Tashtoush 2015 275497; Truong 2018 48; Tung 2001 109; Ujjin 1984 175; Ulger 2016 15; Valero 1986 105; Van der Ham 1990 713; Visintine 1975 415; Wolf 2001 65-67) that reported 52 case reports of injuries/ complications in patients treated with abdominal thrusts.
Chest thrusts/ compressions
For the critical outcome of survival with favorable neurological outcome (n=1 study, Kinoshita 2015 63), important outcome of relief of foreign body airway obstruction (FBAO) (n=1 study, Redding 1979 475) and important outcome of injuries/ complications (n=4 studies, Guinane 2018 1272; Mack 2002 130; Skulberg 1992 91; Tung 2001 109), we identified only observational studies. The overall quality of evidence was rated as very low for all outcomes primarily due to a very serious risk of bias. The individual studies were all at very serious risk of bias due to confounding. Because of this and a high degree of heterogeneity, no meta-analyses could be performed and individual studies are difficult to interpret.
For the critical outcome of survival with favorable neurological outcome, we identified very low certainty evidence downgraded for very serious risk of bias and very serious imprecision from one observational study (Kinoshita 2015 63) enrolling 138 FBAO patients (P), which showed benefit from the use of the intervention (I) compared with control (C) (odds ratio 10.60, 95% CI 2.47-65.06; 501 more patients/1000 survived with the intervention, 95% CI 221 more patients/1000 to 623 more patients/ 1000 survived with the intervention).
For the important outcome of relief of FBAO, we identified very low certainty of evidence downgraded for very serious risk of bias from one case series study (Redding 1979 475) which reported relief of FBAO in 28 patients treated with chest thrusts/ compressions.
For the important outcome of injuries/ complications, we identified very low certainty evidence downgraded for very serious risk of bias from four studies (Guinane 2018 1272; Mack 2002 130; Skulberg 1992 91; Tung 2001 109) that reported five case reports of injuries/ complications in patients treated with chest thrusts/ compressions.
Finger sweep
For the critical outcome of survival (n=1 study, Vilke 2004 196), important outcome of relief of foreign body airway obstruction (FBAO) (n=2 studies, Redding 1979 475; Vilke 2004 196) and important outcome of injuries/ complications (n=8 studies, Abder-Rahman 2009 273; Gjoni 2009 595; Hartrey 1995 52; Heimlich 1977 11; Kabbani 1995 495; Mori 2016 bcr2016216536; Sridharan 2016 33; Vunda 2012 353), we identified only observational studies. The overall quality of evidence was rated as very low for all outcomes primarily due to a very serious risk of bias. The individual studies were all at very serious risk of bias due to confounding. Because of this and a high degree of heterogeneity, no meta-analyses could be performed and individual studies are difficult to interpret.
For the critical outcome of survival, we identified very low certainty of evidence downgraded for very serious risk of bias and serious indirectness from one case series study (Vilke 2004 196) which reported survival in six patients treated with finger sweep.
For the important outcome of relief of FBAO, we identified very low certainty of evidence downgraded for very serious risk of bias and serious indirectness from two case series studies (Redding 1979 475; Vilke 2004 196) which reported relief of FBAO in 36 patients treated with finger sweep.
For the important outcome of injuries/ complications, we identified very low certainty evidence downgraded for very serious risk of bias from eight studies (Abder-Rahman 2009 273; Gjoni 2009 595; Hartrey 1995 52; Heimlich 1977 11; Kabbani 1995 495; Mori 2016 bcr2016216536; Sridharan 2016 33; Vunda 2012 353) that reported 10 case reports of injuries/ complications in patients treated with blind finger sweeps.
Magill forceps
For the critical outcome of survival with favorable neurological outcome (n=1 study, Sakai 2014 53), critical outcome of survival (n=1 study, Sakai 2014 53), and important outcome of relief of foreign body airway obstruction (FBAO) (n=4 studies, Igarashi 2017 1396; Rouillon 2006 1949; Sakai 2014 53; Soroudi 2007 25), we identified only observational studies. The overall quality of evidence was rated as very low for all outcomes primarily due to a very serious risk of bias. The individual studies were all at very serious risk of bias due to confounding. Because of this and a high degree of heterogeneity, no meta-analyses could be performed and individual studies are difficult to interpret.
For the critical outcome of survival with favorable neurological outcome, we identified very low certainty evidence downgraded for very serious risk of bias, serious indirectness and serious imprecision from one observational study (Sakai 2014 53) enrolling 240 FBAO patients (P), which showed benefit from the use of the intervention (I) compared with control (C) (odds ratio 3.96, 95% CI 1.21-13.00; 107 more patients/1000 survived with the intervention, 95% CI 8 more patients/1000 to 324 more patients/ 1000 survived with the intervention).
For the critical outcome of survival, we identified very low certainty evidence downgraded for very serious risk of bias, serious indirectness and serious imprecision from one observational study (Sakai 2014 53) enrolling 240 FBAO patients (P), which showed no benefit from the use of the intervention (I) compared with control (C) (intervention 26.7% v control 17.0%, p=0.086).
For the important outcome of relief of FBAO, we identified very low certainty of evidence downgraded for very serious risk of bias from four case series studies (Igarashi 2017 1396; Rouillon 2006 1949; Sakai 2014 53; Soroudi 2007 25) which reported relief of FBAO in 417 patients treated with magill forceps.
Suction-based airway clearance devices
For the critical outcome of survival (n=1 study, Saperstein 2018), and important outcome of relief of foreign body airway obstruction (FBAO) (n=1 study, Saperstein 2018), we identified only observational studies. The overall quality of evidence was rated as very low for all outcomes primarily due to a very serious risk of bias. The individual studies were all at very serious risk of bias due to confounding. Because of this and a high degree of heterogeneity, no meta-analyses could be performed and individual studies are difficult to interpret.
For the critical outcome of survival, we identified very low certainty of evidence downgraded for very serious risk of bias from one case series study (Saperstein 2018) which survival in 10 patients treated with a suction-based airway clearance device.
For the important outcome of relief of FBAO, we identified very low certainty of evidence downgraded for very serious risk of bias from one case series study (Saperstein 2018) which reported relief of FBAO in 10 patients treated with a suction-based airway clearance device.
FBAO removal by bystanders
For the critical outcomes of survival with favorable neurological outcome (N=1, Igarashi 2017 1396), we only identified a single observational study. The overall certainty of evidence was rated as very low due to a very serious risk of bias. With the identification of only one study, no meta-analyses were performed.
For the critical outcome of survival with good neurological outcome, we identified very low certainty evidence downgraded for very serious risk of bias from one observational study (Igarashi 2017 1396) enrolling 41 patients with FBAO (P) which showed benefit from the intervention (I) compared with no intervention (C) (intervention 73.7% v control 31.8%, p=0.0075).
Treatment Recommendations
We suggest that back slaps are used initially in patients with a FBAO and an ineffective cough (weak recommendation, very low certainty of evidence).
We suggest that abdominal thrusts are used in adults and children with a FBAO and an ineffective cough where back slaps are ineffective (weak recommendation, very low certainty of evidence).
We suggest that rescuers consider the manual extraction of visible items in the mouth (weak recommendation, very low certainty of evidence).
We suggest against the use of blind finger sweeps in patients with a FBAO (weak recommendation, very low certainty of evidence).
We suggest that appropriately skilled individuals consider the use of Magill forceps to remove FBAO in OHCA patients with a FBAO (weak recommendation, very low certainty of evidence).
We suggest that chest thrusts are used in unconscious patients with a FBAO (weak recommendation, very low certainty of evidence).
We suggest that bystanders undertake interventions to support FBAO removal as soon as possible after recognition (weak recommendation, very low certainty of evidence).
Justification and Evidence to Decision Framework Highlights
The task force recognises the importance of early removal of FBAO in order to prevent cardiac arrest.
Bystanders should be encouraged to support patients with FBAO to rapidly remove the obstruction.
The initial response to foreign body airway obstruction in a conscious individual should be to encourage coughing as this is a normal physiological response that may be effective and is unlikely to cause harm. The sequence of interventions in individuals without an effective cough suggested in treatment recommendations seeks to balance the benefits of early removal of the FBAO with the potential harms of interventions, such as abdominal thrusts.
We prioritised consistency with current treatment recommendations. We note the difference in methodological approaches used in this review, compared with previous reviews. In particular, previous reviews included cadaver, animal, and manikin studies.
We note that evidence for all outcomes is assessed as being of very low certainty. Research on FBAO is challenging as many FBAO are treated immediately and effectively by bystanders or by coughing. It is unlikely to be possible to undertake a randomised controlled trial in the area of FBAO.
The task force distinguished between the situation where a FBAO can be visualised in the mouth and the situation where no object can be visualised. Where an obstruction can be visualised in the mouth, the manual removal of the item was considered appropriate. Where an item could not be visualised in the mouth, the potential harm to the casualty associated with the rescuer placing and moving their fingers in the casualty’s mouth (a blind finger sweep) and lack of clear benefit to this approach led to a suggestion against the use of blind finger sweeps.
The task force treatment recommendation limits use of abdominal thrusts to adults and children. This was driven by concerns that in infants the limited protection of the upper abdominal organs by the lower ribs may mean that the harm of abdominal thrusts outweighs any potential benefit. This is consistent with previous treatment recommendations.
The task force treatment recommendation supporting the use of chest thrusts/ compressions is based on evidence from case series of successful relief of FBAO (unknown whether patients in cardiac arrest) and an observational study that found that chest compressions improved neurologically intact survival in unresponsive patients with FBAO. Our current recommendation is consistent with previous treatment recommendations.
The introduction of a treatment recommendation supporting the use of magill forceps by suitably trained individuals reflects the potential benefit of the intervention and the availability of relevant equipment to trained individuals. The task force expects that these trained individuals will already be skilled in advanced airway management. The treatment recommendation is based on evidence from case series of successful relief of FBAO (unknown whether patients in cardiac arrest) and an observational study that found magill forceps use was associated with improved neurologically intact survival in OHCA patients.
The task force acknowledges that there are some data from a case series demonstrating the efficacy of suction-based airway clearance devices. We felt that these data were insufficient to support the implementation of a new technology with an associated financial cost. We noted that the limited number of cases is likely insufficient to provide preliminary data on harm. On this basis, the task force felt that there was insufficient evidence to make a treatment recommendation in relation to these devices. The task force has outlined recommendations for further research in relation to these devices.
Knowledge Gaps
There is a need for high-quality observational studies that accurately describe the incidence of FBAO, patient demographics (age, setting, comorbidities, food type, conscious level), full range of interventions delivered, who delivered interventions (health professional/ lay responder), success rates of interventions, harm of interventions, and outcomes. It is unlikely that such a study can be conducted using only health service data.
There is a need for further evidence on the benefits and harms of suction-based airway clearance devices. The task force would encourage the prospective registration of all device uses. Reports should detail key demographics (e.g. age, setting, comorbidities, food type, conscious level), full range of interventions provided, who provided intervention (lay versus healthcare professional) and outcomes This evidence may initially come in the form of published case series.
Attachments
Evidence-to-Decision Table:BLS-368 Foreign body airway obstruction
References
Abder-Rahman HA. Infants choking following blind finger sweep. Jornal de Pediatria. 2009;85:273-275.
Agia GA and Hurst DJ. Pneumomediastinum following the Heimlich maneuver. JACEP. 1979;8:473-475.
Ayerdi J, Gupta SK, Sampson LN and Deshmukh N. Acute abdominal aortic thrombosis following the Heimlich maneuver. Cardiovascular Surgery. 2002;10:154-6.
Bintz M and Cogbill TH. Gastric rupture after the Heimlich maneuver. Journal of Trauma-Injury Infection & Critical Care. 1996;40:159-60.
Bouayed S, u K, Teiga PS and Hallak B. Thoracocervicofacial Emphysema after Heimlich's Maneuvre. Case Reports in Otolaryngology Print. 2015;2015:427320.
Boussuges S, Maitrerobert P and Bost M. Use of the Heimlich Maneuver on children in the Rhone-Alpes area. Archives Francaises de Pediatrie. 1985;42:733-6.
Caro Aguilera P, Ar P, a R, Perez Ruiz E, Rodriguez Amuedo F and Perez Frias J. Haemoptysis after Heimlich manoeuvre. Anales de Pediatria. 2008;68:533-4.
Con motivo de la reciente aparición de varios dispositivos que se están publicitando como útiles para realizar la desobstrucción de la vía aérea en los atragantamientos, y ante las consultas recibidas en el Consejo Español de Reanimación Cardiopulmonar (CERCP) a propósito de la utilidad de estos dispositivos, el CERCP quiere manifestar que:
El atragantamiento es un accidente que consiste en la obstrucción de la vía aérea por un cuerpo extraño, que generalmente puede ser un alimento o cualquier objeto sólido, y en los niños habitualmente también pequeñas piezas de juguetes.
Este objeto o alimento obstruye la entrada de aire en la garganta de la víctima, provocando un cuadro repentino de asfixia que si no se resuelve en pocos minutos, de manera espontánea o con ayuda externa, conduce a una disminución muy importante de oxígeno en la sangre, que provoca una pérdida del conocimiento y que llevará a una situación de parada cardiorrespiratoria y muerte cerebral sí no se consigue resolver el episodio
lifevac dehockerLa SEORL (Sociedad Española de Otorrinolaringología) ha comunicado un total de 2.336 personas fallecidas por esta causa en España, de los cuales 2.212 personas tenían una edad por encima de 65 años y el resto de los 124 pacientes entre los 2-4 años. Las personas ancianas suelen tener problemas para tragar alimentos sólidos e incluso líquidos, esto se llama disfagia y suele estar asociado a diferentes enfermedades como las demencias, accidentes cerebrovasculares, Parkinson, etc. y pueden producir un atragantamiento
A lo largo de los años, se han descrito diferentes maniobras para desobstruir de la vía aérea por un atragantamiento. Desde 1933 la Cruz Roja Americana recomendaba los golpes en la espalda (interescapulares) en caso de atragantamiento. Hacia 1970, técnicas como los golpes interescapulares y las compresiones torácicas, fueron recomendadas por la “Cruz Roja Americana” y la “American Heart Association” (Asociación Americana del Corazón) para solventar el problema del atragantado. En 1974 se publica la maniobra de Heimlich, consistente en la compresión abdominal del paciente para conseguir expulsar el objeto extraño, conociéndose en la actualidad como “compresiones abdominales”.
En la actualidad, las guías internacionales Americanas y Europeas para la desobstrucción de la vía aérea, recomiendan tanto en adultos como en niños mayores de un año de edad, para los casos de obstrucciones graves o completas en el paciente consciente la maniobra de 5 golpes interescapulares y 5 compresiones abdominales, mientras que en las obstrucciones incompletas (con tos eficaz) se recomienda estimular a que el paciente tosa.
sintomas tosEste tipo de maniobra no está exenta de posibles complicaciones, y aunque son poco frecuentes, están descritas algunas, como lesiones traumáticas de estómago, esófago, yeyuno, contusiones mesentéricas, aspiración traqueal tras vómito, etc. No obstante, el riesgo de producir potenciales escasas lesiones se ve claramente superado por el amplísimo beneficio de poder acabar con el atragantamiento.
DISPOSITIVOS ANTIATRAGANTAMIENTO.
En los últimos años, hemos asistido a la implementación y salida al mercado de varios de ellos. En la actualidad, en el mercado español existen 2 dispositivos:
Lifevac
Dechoker
LIFEVAC
lifevac 3
Consiste en una máscara parecida a las mascarillas de ventilación que se utilizan habitualmente, y que permite el sellado a la cara.
Un segundo componente de este dispositivo es un generador de succión parecido a un embolo. Es parecido a un “desatascador” que origina una aspiración al comprimirla. La conexión entre los dos componentes dispone de una válvula unidireccional que controla la dirección de la presión del flujo de aire hacia el exterior e impide que le cuerpo extraño se desplace hacia abajo
Respecto a las experiencias publicadas en la bibliografía médica internacional acerca del uso de éste dispositivo, solo hay publicados algunos ensayos a nivel experimental en animales, en cadáveres y en modelos de simulación con maniquíes. Se han referenciado una serie escasa de empleo anecdótico de este dispositivo en personas vivas, que no son concluyentes para afirmar su efectividad y sobre todo su seguridad de uso y posibles efectos perjudiciales para el paciente en las estructuras faringolaríngeas o en los pulmones
DECHOKER
Dechoker 3Este dispositivo consta de una mascarilla para sellado de boca y nariz. Tiene un tubo que se coloca encima de la lengua y todo ello va unido a un cilindro con un embolo para la aspiración.
Hay dispositivos para niños a partir de 12 meses y otros dos modelos más según edad y tamaño.
No hemos encontrado ninguna referencia en la literatura de este dispositivo, ni sabemos qué tipo ni intensidad de succión que realiza.
Ambos dispositivos están registrados en la FDA (agencia del gobierno de los Estados Unidos responsable entre otros, de la regulación de medicamentos y material de uso sanitario) como un dispositivo de succión.
CONCLUSIONES:
Tras analizar la escasa bibliografía médica disponible en la actualidad, acerca de la indicación y seguridad de uso de estos dispositivos en los atragantamientos y teniendo en cuenta las altas presiones de succión que se han detectado, que podrían ser dañinas para el paciente, especialmente para el niño, el CERCP recomienda seguir actuando ante los atragantamientos tal y como indican las recomendaciones internacionales mediante la tos, golpes en la espalda y compresiones abdominales.
Es necesario disponer en el futuro de más estudios para poder concluir que el uso de estos dispositivos es eficaz y seguro para los pacientes y que sea incorporado a las Guías internacionales como un método para utilizar en los atragantamientos.
Can New Devices Match Heimlich to Stop Choking? LifeVac and Dechoker pose alternative to abdominal thrusts
By LAURA JOHANNES
Muere un niño de tres años al atragantarse con una uva en Gijón. España
1/1/2019
leer mas https://emssolutionsint.blogspot.com/2016/07/heimlich-manueuver-vs-lifevac.html
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| HEIMLICH MANEUVER vs LifeVac (DeschO2ker) for Airway Obstructions |
Aquí la Radiografía Rx de un paciente pediátrico de 5 años de edad, con una uva en su vía aérea que requirió de cirugía para extraer la uva y como fue una obstrucción parcial y no total el paciente no murió por atragantamiento, las uvas se dan a los niños partidas nunca enteras! -Aprenda primeros auxilios uno nunca sabe cuando los va ocupar ...... 🚑 del muro de facebook de Emmanuel Patiño
Can New Devices Match Heimlich to Stop Choking?
LifeVac and Dechoker pose alternative to abdominal thrusts
Mas información en www.lifevac.es
¿Pueden los nuevos dispositivos igualar la Maniobra de Heimlich en Obstrucción de vias Aéreas por Cuerpo Extraño? LifeVac y Dechoker se plantean como alternativa a los compresiones abdominales.
Can New Devices Match Heimlich to Stop Choking? LifeVac and Dechoker pose alternative to abdominal thrusts
UN NIÑO SALVADO EN UN RESTAURANTE DE IKEA GRACIAS AL DISPOSITIVO ANTI ATRAGANTAMIENTO LIFEVAC!
Celebramos la noticia de un niño de 3 años salvado gracias al dispositivo LifeVac. El niño se atragantó con un perrito caliente y aunque le practicaron la Maniobra de Heimlich, ésta no funcionó. LIFEVAC SALVA VIDAS CUANDO LA MANIOBRA DE HEIMLICH NO FUNCIONA.
Mas información en www.lifevac.es 
¿Pueden los nuevos dispositivos igualar la Maniobra de Heimlich en Obstrucción de vias Aéreas por Cuerpo Extraño? LifeVac y Dechoker se plantean como alternativa a los compresiones abdominales.
Can New Devices Match Heimlich to Stop Choking? LifeVac and Dechoker pose alternative to abdominal thrusts
By LAURA JOHANNES
The Ache: Nearly 5,000 people a year die from choking in the U.S., according to the nonprofit National Safety Council.
The Claim: Two new easy-to-use devices work like plungers to suck out obstructions in the airway, providing another option if standard treatment—such as abdominal thrusts developed in 1974 by Henry Heimlich—fail to clear the airway, say the companies who sell them.
The Verdict: A recently published laboratory study showed the LifeVac, from LifeVac LLC of Springfield Gardens, N.Y., dislodged simulated obstructions. So far there haven’t been any scientific publications detailing lives saved with the LifeVac or another device, from Dechoker LLC, of Salisbury, N.C.
Both the Dechoker, $89.95, and the LifeVac, $69.95, have a plastic mask that provides a seal over the mouth and nose while suction is provided. The Dechoker looks like a large syringe, while the LifeVac’s plunger is shaped like a small accordion. In both devices, one-way valves allow air to only travel out of the mask and not into it, which avoids pushing the object deeper in, says LifeVac Chief Executive Arthur Lih.
While the devices “theoretically” could work, there isn’t enough evidence for them, says New Orleans physician Jay Kaplan, president of the American College of Emergency Physicians. There are a number of potential pitfalls, including whether a panicking choking victim would let a rescuer put a mask on the mouth, he adds.
Early adopters of the devices include people with chronic diseases at high risk for choking. “This is a very simple device which people can have on hand,” says Port Charlotte, Fla., neurologist William Holt. He says he recommends the LifeVac to his multiple-sclerosis patients, as the disease interferes with the muscular coordination involved in swallowing. Dr. Holt says he works as a volunteer adviser to LifeVac but has no financial link to the company.
Skeptics include Dr. Heimlich, now 96. Such a device may not be handy in the “unexpected instance that a person chokes,” Dr. Heimlich, a retired thoracic surgeon from Cincinnati, says in a statement released by his son, Phil Heimlich. “Any action that delays use of the Heimlich maneuver or complicates the rescue can be deadly.”
If a person is choking and isn’t able to cough out the obstruction, the American Heart Association recommends a rapid sequence of abdominal thrusts. If that doesn’t work, or if you can’t get your arms around the victim, due to obesity or pregnancy, another option is thrusting around the chest area, adds Clifton Callaway, chairman of the AHA’s Emergency Cardiovascular Care committee. The American Red Cross recommends using five back blows, followed by five abdominal thrusts, repeating as needed.
EFE/EP@abc_conocer . Oviedo Actualizado: 01/01/2019 12:33h
Muere un niño de tres años al atragantarse con una uva en Gijón
El pequeño llegó al centro sanitario sin respiración ni pulso por lo que los intentos de reanimación que se le realizaron resultaron infructuosos
Un niño de tres años falleció anoche en Gijón tras atragantarse con una de las tradicionales uvas de Nochevieja en su domicilio de la calle Independencia, ubicada en el barrio del Natahoyo, según han informado fuentes municipales.
Según las mismas fuentes, después de que el pequeño se atragantara con la uva, los padres avisaron a la Policía Local que se desplazó a la vivienda y evacuó al menor al hospital de Jove.
El trágico suceso se produjo en el barrio de El Natahoyo, concretamente en la calle Independencia. La familia, de origen ecuatoriano, estaba celebrando la despedida del año 2018.
El niño llegó al centro sanitario sin respiración ni pulso por lo que los intentos de reanimación que se le realizaron resultaron infructuosos.
 |
| HEIMLICH MANEUVER vs LifeVac (DeschO2ker) for Airway Obstructions |
The LifeVac and the Dechoker are both intended to be used if standard rescue treatments fail, the companies say. One person can get the device while another person starts the Heimlich maneuver, suggests Sean Pittman, Dechoker’s director of strategic development.
The American Heart Association, which last updated its guidelines on choking rescue in 2010, looks for published reports in scientific journals that a technique has a record of successful uses before recommending it, the group says.
On the market less than two years, neither LifeVac nor Dechoker has published evidence of successful uses in humans. Two users have told Dechoker that the device successfully dislodged an obstruction, says Mr. Pittman. In a recent case of an elderly woman in Wales, the LifeVac removed an obstruction after standard treatments failed, says Mr. Lih. The company doesn’t yet have full details on the case, he adds.
In a study published online in March in the American Journal of Emergency Medicine, the LifeVac successfully removed test obstructions made of clay from the upper airway of a cadaver. “It worked 49 out of 50 times on the first try,” says study co-author Mimi Juliano, a Farmingdale, N.Y., speech pathologist who specializes in swallowing disorders. The one time the device failed on the first try, researchers didn’t have a good seal around the mouth, she says; it worked the second time.
Taken from http://www.wsj.com/articles/can-new-devices-match-heimlich-to-stop-choking-1468242002
The “Highlights of the 2015-2020 American Heart Association Guidelines for CPR and ECC “ / Summary of the main changes in the Resuscitation "Guidelines ERC GUIDELINES 2015" / Recomendaciones para la Resucitación 2015 del Consejo Europeo de Resucitación (ERC) 2015 / Principales novedades para las nuevas guías de RCP de International Liason Committee on Resuscitation ILCOR 2015-2020
CERCP NO RECOMIENDA DISPOSITIVOS para OBSTRUCCION DE VIAS AEREAS ¿Pueden los nuevos dispositivos igualar la Maniobra de Heimlich en Obstrucción de vias Aéreas por Cuerpo Extraño? LifeVac y Dechoker se plantean como alternativa a los compresiones abdominales. Can New Devices Match Heimlich to Stop Choking? LifeVac and Dechoker pose alternative to abdominal thrusts
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