Life-threatening foreign body airway obstruction: Case series and new classification proposal - 16/03/19

Doi : 10.1016/j.ajem.2019.03.015

Yutaka Igarashi, MD, PhD ^a,^{^⁎} , Tatsuya Norii, MD ^b, Kim Sung-Ho, MD ^c, Shimpei Nagata, MD ^d, Takashi Tagami, MD, MPH, PhD ^e,^f, Jon Femling, MD, PhD ^b, Yasuaki Mizushima, MD, PhD ^d, Hiroyuki Yokota, MD, PhD ^a
^a Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
^b Department of Emergency Medicine, University of New Mexico, Albuquerque, USA
^c Department of Critical Care Medicine, Osaka Habikino Medical Center, Osaka, Japan
^d Department of Emergency Medicine, Osaka Police Hospital, Osaka, Japan
^e Health Services and Systems Research, Duke-NUS Medical School, Singapore
^f Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan

^⁎Corresponding author at: 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.1-1-5 Sendagi, Bunkyo-kuTokyo113-8603Japan

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Abstract

Introduction

Foreign body airway obstruction (FBAO) is a common medical emergency; however, few studies of life-threatening FBAO have been reported and no standard classification system is available.

Methods

We retrospectively evaluated patients who presented to the emergency departments of two hospitals and were diagnosed with FBAO. The primary outcome was cerebral performance category (CPC) score at discharge. To establish a new classification system for FBAO, FBAO was classified into three types based on the anatomical and physiological characteristics of the obstructed airway.

Results

A total of 137 patients were enrolled. Median age was 79.0 years. The most common cause of FBAO was meat, followed by bread, rice cake, and rice. Of all patients, 65.7% suffered cardiac arrest and 51.1% died. In contrast, 28.5% had favorable neurological outcomes, defined as CPC 1 and 2. Upper airway obstruction (type 1) was the most common (type 1, 78.1%), while trachea and/or bilateral main bronchus obstruction (type 2, 12.4%) showed significantly higher mortality than type 1 obstruction (82.4% vs 47.7%, P = 0.0078). Patients with unilateral bronchus and/or distal bronchus obstruction (type 3, 9.5%) were significantly more likely to consume a dysphagia diet than type 1 patients (23.1% vs 0%, P < 0.0001).

Conclusion

The majority of patients with life-threatening FBAO were elderly and had poor neurological outcomes. Our new classification system divides FBAO into three types, and revealed that mortality was significantly higher with type 2 than type 1 obstruction. This classification system may improve the management of patients with FBAO and assessment of patient outcomes.

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Keywords : Foreign body airway obstruction, Airway, Bronchoscopy, Cardiac arrest