Carballo-Fazanes Aida, Izquierdo Verónica, Mayordomo-Colunga Juan, Unzueta-Roch José Luis, Rodríguez-Núñez Antonio
CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain.
Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, RD21/0012/0025, Madrid, Spain.
Resusc Plus. 2024 Jun 26;19:100695. doi: 10.1016/j.resplu.2024.100695. eCollection 2024 Sep.
Recent emergence of airway clearance devices (ACDs) as a treatment alternative for foreign body airway obstructions (FBAO) lacks substantial evidence on efficacy and safety. This study aimed to assess pediatric residents' knowledge and skills in managing a simulated pediatric choking scenario, adhering to recommended protocols, and using LifeVac© and DeCHOKER© ACDs.
Randomized controlled simulation trial, in which 60 pediatric residents from 3 different hospitals (median age 27 [25.0-29.9]; 76.7% female) were asked to solve an unannounced pediatric simulated choking scenario using three interventions to manage (randomized order): 1) following the recommended protocol of the European Resuscitation Council (encouraging to cough or combination of back blows and abdominal thrusts); 2) using LifeVac©; and 3) using DeCHOKER©. A Little Anne QCPR™ manikin (Laerdal Medical) was used. The variable compliance rate (%) was calculated according to the correct/incorrect execution of the steps constituting the proper actions for each test.
Participants demonstrated a correct compliance rate only ranging between 50-75% in following the recommended protocol for managing partial FBAO progressing to severe. Despite unfamiliarity with the ACDs, pediatric residents achieved rates between 75% and 100%, with no significant difference noted between the two devices ( = 0.173). Both scenarios were successfully resolved in under a minute, with LifeVac© demonstrating a significantly shorter response time compared to DeCHOKER© (39.2 [30.4-49.1] vs. 45.1s [33.7-59.2], = 0.010).
Only a minority of pediatric residents were able to adhere to the recommended FBAO protocol, whereas 70% of them were able to adequately use the ACDs. However, since a significant proportion could not, it seems that ACDs themselves do not address all issues.
气道清除装置（ACDs）作为治疗异物气道梗阻（FBAO）的一种替代疗法，近期才出现，其疗效和安全性缺乏充分证据。本研究旨在评估儿科住院医师在处理模拟儿科窒息场景、遵循推荐方案以及使用LifeVac©和DeCHOKER©气道清除装置方面的知识和技能。
随机对照模拟试验，来自3家不同医院的60名儿科住院医师（中位年龄27岁[25.0 - 29.9]；76.7%为女性）被要求使用三种干预措施（随机顺序）解决未事先通知的儿科模拟窒息场景：1）遵循欧洲复苏委员会的推荐方案（鼓励咳嗽或背部叩击与腹部冲击相结合）；2）使用LifeVac©；3）使用DeCHOKER©。使用了Little Anne QCPR™人体模型（Laerdal Medical）。根据构成每个测试正确操作步骤的正确/错误执行情况计算可变依从率（%）。
在遵循处理从部分FBAO进展为严重FBAO的推荐方案方面，参与者的正确依从率仅在50%至75%之间。尽管对气道清除装置不熟悉，但儿科住院医师的成功率在75%至100%之间，两种装置之间未发现显著差异（P = 0.173）。两种场景均在1分钟内成功解决，与DeCHOKER©相比，LifeVac©的反应时间明显更短（39.2秒[30.4 - 49.1]对45.1秒[33.7 - 59.2]，P = 0.010）。
只有少数儿科住院医师能够遵循推荐的FBAO方案，而其中70%能够充分使用气道清除装置。然而，由于相当一部分人做不到，似乎气道清除装置本身并不能解决所有问题。
