title: Relationships between pre-hospital characteristics and outcome in victims of foreign body airway obstruction during meals.
abstract: OBJECTIVE
  The purpose of this study is to determine the outcome of foreign body airway obstruction according to the initial actions taken for choking victims during meals.
  
  
  METHODS
  Our subjects were patients who became unresponsive or unconscious because of foreign body airway obstruction (FBAO) during meals in the presence of bystander witnesses. We investigated the associations between outcome and the following factors: age, gender, type of foreign body, chest compressions after the patient became unresponsive or unconscious, episode of cardiac arrest, efforts by a bystander to remove the foreign body, eating-related activities of daily living, time elapsed from the 119 call to arrival of emergency medical technicians (EMTs), and time elapsed from the 119 call to hospital arrival (primary endpoint).
  
  
  RESULTS
  Of the 138 patients enrolled during the study period, 35 (25.4%) received chest compressions by bystanders after becoming unresponsive or unconscious and 69 (50.0%) suffered cardiac pulmonary arrest. Chest compressions by a bystander after the victim became unresponsive or unconscious (p<0.0001) and no CPA (p<0.0001) were significantly related to good outcome. Chest compressions by a bystander were both associated with good neurological outcome (odds ratio, 10.57; 95% CI, 2.472-65.059, p<0.0001). No CPA after FBAO was another independent predictor (odds ratio, 50.512; 95% CI, 13.45-284.41; p<0.0001), but efforts to remove the foreign body before the arrival of EMTs did not affect outcome.
  
  
  CONCLUSIONS
  Chest compressions by a bystander, a support received by only 25% of the patients, proved to be essential for improved outcome for choking victims who became unresponsive or unconscious. Education for lay-rescuer response to choking might further improve overall outcome.
authors.affiliation: Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Japan. Electronic address: kinoshita.kosaku@nihon-u.ac.jp.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Kinoshita
authors.affiliation: Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Azuhata
authors.affiliation: Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kawano
authors.affiliation: Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Japan.
authors.forename: Yayoi
authors.initials: Y
authors.lastname: Kawahara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000150:complications* / Q000628:therapy; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004632:Emergency Medical Services; D005260:Female; D005547:Foreign Bodies / Q000150:complications*; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Airway obstruction; Chest compression; Choking; Foreign body