A 2-year prospective evaluation of airway clearance devices in foreign body airway obstructions

Aim: To collect, analyze and report the first prospective, industry-independent, data on airway clearance devices as novel foreign body airway obstruction interventions. Methods: We recruited adult airway clearance device users between July 1, 2021 and June 30, 2023 using a centralized website and email follow-up. The data collection tool captured patient, responder, situation, and outcome variables. Multi-step respondent validation occurred using electronic and geolocation verification, a random selection follow-up process, and physician review of all submitted cases. Results: We recruited 186 airway clearance device users (LifeVac©:157 [84.4%]; Dechoker©:29 [15.6%]). LifeVac© was the last intervention before foreign body airway obstruction relief in 151 of 157 cases. Of these, 150 survived to discharge. A basic life support intervention was used before LifeVac© in 119 cases, including the 6 cases where LifeVac© also failed. We identified two adverse events using LifeVac© (perioral bruising), while we could not ascertain whether another 7 were due to the foreign body or LifeVac© (3 = airway edema; 3 = oropharyngeal abrasions; 1 = esophageal perforation). Dechoker© was the last intervention before obstruction relief in 27 of 29 cases and all cases survived. A basic life support intervention was used before Dechoker© in 21 cases, including both where Dechoker© also failed. We identified one adverse event using Dechoker© (oropharyngeal abrasions). Conclusion: Within these cases, airway clearance devices appear to be effective at relieving foreign body airway obstructions. However, this data should be considered preliminary and hypothesis generating due to several limitations. We urge the resuscitation community to proactively evaluate airway clearance devices to ensure the public remains updated with best practices. © 2023 The Author(s)Dr. Amy Peden is funded by a National Health and Medical Research Council (NHMRC) Emerging Leadership Fellowship (Grant ID: APP2009306) which supported open access publication. No funding was obtained for the conduct of the study

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

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

MUNICÍPIO RESILIENTE EM AFOGAMENTO

De acordo com a Organização Mundial da Saúde, afogamento é uma grave ameaça negligenciada à saúde pública, sendo que morrem em média 372.000 pessoas por ano em todo o mundo; 40 pessoas a cada hora do dia. No Brasil quase 1 milhão de pessoas se afogam e 5.700 morrem por afogamento a cada ano, sendo mais de 75% em rios, lagos e represas onde não existe nenhuma supervisão de guarda-vidas. Tendo em vista esta trágica realidade, é fundamental criar mecanismos de resiliência para estes locais, tendo como atores centrais os municípios, de forma a melhor efetivarem a gestão de riscos de afogamento em suas áreas geográficas

Probing Chemical Space with Alkaloid-Inspired Libraries

Screening of small molecule libraries is an important aspect of probe and drug discovery science. Numerous authors have suggested that bioactive natural products are attractive starting points for such libraries, due to their structural complexity and sp3-rich character. Here, we describe the construction of a screening library based on representative members of four families of biologically active alkaloids (Stemonaceae, the structurally related cyclindricine and lepadiformine families, lupin, and Amaryllidaceae). In each case, scaffolds were based on structures of the naturally occurring compounds or a close derivative. Scaffold preparation was pursued following the development of appropriate enabling chemical methods. Diversification provided 686 new compounds suitable for screening. The libraries thus prepared had structural characteristics, including sp3 content, comparable to a basis set of representative natural products and were highly rule-of-five compliant

Nonfatal Drowning in People with Parkinson's Disease

We read with great interest the recent case report by Tosserams and colleagues on a 56-year-old proficient swimmer and the decline in his swimming abilities attributed to Parkinson's disease. We also appreciate the earlier article by Neves and colleagues on the risk of drowning in people with Parkinson's disease. We applaud the authors for raising awareness of drowning as a consequence of a decline in swimming abilities, particularly in the context of Parkinson's disease. Our concern, and reason for corresponding, is the continued use of outdated terminology in the title and text of both articles, namely the term near drowning

Nonfatal Drowning in People with Parkinson's Disease

We read with great interest the recent case report by Tosserams and colleagues on a 56-year-old proficient swimmer and the decline in his swimming abilities attributed to Parkinson's disease. We also appreciate the earlier article by Neves and colleagues on the risk of drowning in people with Parkinson's disease. We applaud the authors for raising awareness of drowning as a consequence of a decline in swimming abilities, particularly in the context of Parkinson's disease. Our concern, and reason for corresponding, is the continued use of outdated terminology in the title and text of both articles, namely the term near drowning