A systematic review on the effectiveness of anti-choking suction devices and identification of research gaps

Abstract

Aim: Despite an obstructed airway (choking) being a relatively preventable injury, it has a considerable mortality burden globally, with increasing incidence. Given new technologies in choking management, this systematic review aimed to assess current literature on the effectiveness of anti-choking suction devices at relieving obstructions.

Methods: Ovid MEDLINE, Embase, PubMed, The Cochrane Library, SCOPUS, Web of Science, CINAHL Plus and the English websites of the devices were searched on September 23, 2019. Studies were included if they reported the anti-choking devices' dislodgment success rate (primary outcome) or associated adverse events (secondary outcome). Articles, conference abstracts or technical reports were included if peer reviewed. Certainty of evidence was assessed in accordance with GRADE.

Results: Five studies satisfied the inclusion criteria for this review. Two studies (40%) reported findings of a single centre mannequin trial, one (20%) of a single centre cadaveric trial, and two (40%) were case series. Cohen's Kappa for the first and second round of screening was 0.904 and 0.674 respectively. Although several devices have been manufactured worldwide, the LifeVac© has been most extensively studied, with a combined dislodgement success rate of 94.3% on first attempt. However, certainty of evidence for the primary outcome was evaluated as very low.

Conclusions: There are many weaknesses in the available data and few unbiased trials that test the effectiveness of anti-choking suction devices resulting in insufficient evidence to support or discourage their use. Practitioners should continue to adhere to guidelines authored by local resuscitation authorities which align with ILCOR recommendations.

Keywords: Airway management; Airway obstruction; Anti-choking device; Basic life support; Choking; Layperson intervention; Suction device; Systematic review.