Evaluation of DeChoker, an Airway Clearance Device (ACD) Used in Adult Choking Emergencies Within the Adult Care Home Sector: A Mixed Methods Case Study

Abstract

Foreign Body Airway Obstruction (FBAO) is a medical emergency that can result in death, particularly if swift, appropriate action is not taken. It can be a frightening experience for all involved. DeChoker, an Airway Clearance Device (ACD), might provide an additional alternative in the management of choking; however, limited evidence around its safety and effectiveness makes adoption controversial.Objectives: An independent evaluation to explore the experiences of health and care professionals who used DeChoker in real-life adult choking emergencies, focusing on the product's safety, efficacy and ease of application.Design: Retrospective mixed methods case study, with multiple embedded units of analysis.Setting: UK adult care homes.Participants: Twenty seven incidents of adult choking emergencies self-reported by care home staff where DeChoker was used. This data was augmented by an in-depth exploration of four individual choking incidences.Results: The choking victim's ages range: 45 to 101 years (mean 79.8 years). The device was reported to have successfully removed the obstruction in 26 of 27 cases, with very few complications or adverse events reported. In 21 of 27 incidents (78%) the victim was not required to visit Accident and Emergency. Qualitative data indicated nursing home staff found the DeChoker easy to use and valued its presence as an adjunct to current guideline procedures.Conclusion: There is a dearth of evidence surrounding the management of choking and little innovation in this area for five decades. This retrospective evaluation contributes to discussion regarding the role ACDs might play in the management of choking, particularly in cases where current choking management guidance are ineffective, insufficient, inappropriate or impractical (e.g., frail or movement restricted people). The interview data presents a view from care home staff that the DeChoker, as an ACD, contributed to saving the life of choking victims.

The efficacy of two commercially available devices for airway foreign body relief: A cadaver study

“…The literature also describes anecdotal evidence of success with both the LifeVac and DeChoker in two case reports 7,8 . Of note, there are a few relevant factors between the two studies that must be considered despite the reported high PNSD efficacy.…”

“…Within the literature found, there are multiple studies and case series, which report data that may find these two devices effective upon initial examination. 4 , 6 , 7 , 8 , 9 , 10 For example, multiple mannequin trials report significant success in dislodgement with LifeVac use. 4 , 6 , 9 , 10 Although these studies represent optimistic outcomes, this data may not be generalizable.…”

“…Previous studies on PNSDs include cadaver studies, case reports, and mannequin trials, some of which report significant success in dislodging the foreign body upon an initial examination of the data. 4 , 5 , 6 , 7 , 8 , 9 , 10 A thorough systematic review by Dunne et al, however, details notable flaws in these studies namely a high risk of bias (industry involvement, and reporting bias), decreased generalizability of mannequin results, and a low certainty of evidence despite high success rates of dislodgement. 11 Therefore, it is commonly recognized that further independent studies must be conducted.…”

Phase One of a Global Evaluation of Suction-Based Airway Clearance Devices in Foreign Body Airway Obstructions: A Retrospective Descriptive Analysis

“…This study is the first of a multi-phase global evaluation of ACDs that aims to determine their effectiveness and clarify their role (if any) in future choking intervention algorithms [ 15 ]. Prior to this study, most published data were limited to mannequin studies, case reports with few entries, or only focused on a subset of the population [ 8 , 9 , 14 , 21 , 22 ]. This study included all ACD intervention data available, incorporating all ages from all regions of the world.…”

“…No injury was found due to LifeVac in the cadaver evaluation [ 26 ]. Other studies have limited information on safety [ 8 , 9 , 14 , 21 , 22 ]. Unfortunately, self-reporting has been shown to have poor sensitivity for detecting adverse events [ 24 , 25 ], which is compounded in this study by limited patient follow up and the data quality concerns described previously.…”