Dr Belinda Delardes1, Mr Timothy Kent1, Mrs Tara Ralph1, Ms Jenna Schwarz1, Ms Ashanti Dantanarayana1, Dr Tegwyn McManamny1,2, Assoc Prof Ziad Nehme1,2
1Ambulance Victoria, Melbourne, Australia, 2Monash University, Melbourne, Australia
Biography:
Belinda Delardes is a paramedic clinician researcher who recently completed her PhD examining improvements in paramedic to primary care referral pathways. She works as a flight paramedic and serves as a resuscitation coordinator with Ambulance Victoria, contributing to cardiac arrest quality and system performance.
Abstract:
Aims: Foreign body airway obstruction (FBAO) is a time critical emergency that can rapidly progress to cardiac arrest. Despite its clinical significance, contemporary epidemiological data describing out of hospital cardiac arrest (OHCA) precipitated by FBAO remain limited.
Methods: We conducted a retrospective analysis of all EMS attended OHCA cases in Victoria, Australia (1 July 2020–30 June 2024) recorded in the Victorian Ambulance Cardiac Arrest Registry. All arrests attributed to FBAO were included. We extracted data to characterise the sequence, type, and effectiveness of interventions used to relieve obstruction.
Results: Of 29,684 OHCAs, 223 (0.8%) were due to FBAO. Median age was 77 years, and most events occurred in private residences (56%) or residential care homes (30%). Sixteen percent of patients received no bystander intervention. The most common paramedic interventions were CPR (n=171, 84.2%), Magill’s forceps (n=119, 58.6%) and suction (n=111, 54.7%). Magill’s forceps and intubation were the most effective techniques for establishing effective ventilation (each with 73% success when used), whereas laryngeal mask airway devices were frequently used (n=67, 35%) but rarely effective (7%). Obstruction removal was documented in 165 (74%) patients; however, only 8 (3.6%) survived to hospital discharge. In the cohort of patients over the age of 65 (n=165) years, there were no survivors.
Conclusion: OHCA secondary to FBAO is rare and associated with extremely poor survival, particularly in older adults. These findings highlight the need for improved early recognition, enhanced bystander response, and reconsideration of aggressive resuscitation in frail patients where choking may represent a terminal event.