Airway obstruction time and outcomes in patients with foreign body airway obstruction: multicenter observational choking investigation

Abstract

Aim: Foreign body airway obstruction (FBAO) is a major public health concern worldwide for infants and older adults. This study determines the association between airway obstruction time and neurological outcomes to plan an effective response for patients with FBAO.

Methods: This multicenter retrospective observational study was carried out among patients with life-threatening FBAO in Japan over a period of 4 years. The duration of airway obstruction was calculated from the time of the accident to the time of foreign body removal. The study examined the relationship between airway obstruction time and outcome. The primary outcome was vegetative state or death at hospital discharge.

Results: Among 119 patients, 68 were in the category of vegetative state or death. Logistic regression analysis showed that longer airway obstruction time (adjusted odds ratio 1.04; 95% confidence interval 1.01-1.07) was associated with vegetative state or death. When the cut-off value was set at 10, the sensitivity was 0.88, the specificity 0.47, with the area under the curve 0.69. Using the other cut-off value of 4 min, the negative predictive value was 1.00.

Conclusion: Longer airway obstruction time was associated with vegetative state or death for patients with FBAO. The incidence of vegetative state or death increased when the airway obstruction time exceeded 10 min. Meanwhile, 4 min or less may be set as a target time for foreign body removal in order to prevent vegetative state or death and plan an effective response.

Keywords: Airway management; cardiac arrest; foreign body airway obstruction; resuscitation; vegetative state.

Fig. 1

Flowchart showing recruitment of 119 Japanese patients with foreign body airway obstruction into the Multicenter Observational Choking Investigation (MOCHI) study.

Fig. 2

Relationship between airway obstruction time and neurological outcome (measured by cerebral performance category [CPC]) in 119 Japanese patients with foreign body airway obstruction. CPC 1, good cerebral performance, conscious, alert, able to work and lead a normal life; CPC 2, moderate cerebral disability, conscious, sufficient cerebral function for part‐time work in sheltered environment; CPC 3, severe cerebral disability, conscious, dependent on others; CPC 4, coma, vegetative state, not conscious; CPC 5, death, certified brain dead or dead by traditional criteria.

Fig. 3

Receiver operating characteristic curve showing the time to removal of airway obstruction. When the cut‐off value was set at 10 min, the sensitivity was 0.88, the specificity 0.47, the positive predictive value 0.69, and the negative predictive value 0.75. Area under curve was 0.69 (95% confidence interval, 0.59–0.80).