Comparison of extraction devices for the removal of supraglottic foreign bodies.
OBJECTIVE
By using a porcine model, the efficacy of various extraction devices for airway foreign body removal was examined.


METHODS
The upper airways of euthanized swine were occluded with a rubber ball, glass marble, or grape. A Magill forceps, a spongestick forceps, and a nasal trumpet attached to suction were used by test subjects for foreign body removal. Extraction success and time were recorded for each removal attempt. Satisfaction scores were recorded for each foreign body and device combination.


RESULTS
Seven paramedics, seven residents, and seven attending physicians participated. A total of 189 attempts were analyzed. Success rates for foreign body extraction with Magill and spongestick forceps were similar, with both devices superior to nasal trumpet (98% and 97% vs. 83%, respectively, p < 0.001). For successful ball removal attempts, the mean extraction time with spongestick forceps was less than those for both Magill forceps and nasal trumpet: 12.4 (95% confidence interval [CI], 10-14.7) versus 23.4 (95% CI, 16.3-30.3) and 21.2 (95% CI, 14.2-28.3) seconds, respectively. For marble removal, the mean extraction time with spongestick forceps also was less than Magill forceps and nasal trumpet: 10.8 (95% CI, 8.7-12.8) versus 18.4 (95% CI, 12.8 to 23.8) and 16.7 (95% CI, 12.6-20.8) seconds, respectively. For grape removal, the mean extraction times with both spongestick and Magill forceps were less than that of nasal trumpet: 11.8 (95% CI, 7.1 to 16.4) and 8.1 (95% CI, 6.8-9.4) versus 15.6 (95% CI 10-21.2) seconds, respectively. Subjects preferred the spongestick forceps for removal of the glass and rubber ball to the Magill forceps and nasal trumpet.


CONCLUSIONS
In this porcine model, the SF appeared to be the most efficient and preferred device for extracting the type of airway foreign body that is associated with fatal asphyxiation.
Higgins
George L
GL
Department of Emergency Medicine, Maine Medical Center, Portland, Maine, USA. higgig@mmc.org
Burton
John H
JH
Carter
W Phelps
WP
Floor
Amy E
AE
D000402:Airway Obstruction / Q000601:surgery*; D000818:Animals; D001237:Asphyxia / Q000517:prevention & control; D004502:Education, Medical, Continuing; D004635:Emergency Medicine / Q000193:education / Q000295:instrumentation*; D005547:Foreign Bodies / Q000150:complications / Q000601:surgery*; D023421:Models, Animal; D010036:Otolaryngology / Q000193:education / Q000295:instrumentation*; D013525:Surgical Instruments / Q000145:classification*; D013552:Swine; D013996:Time and Motion Studies