May 26, 2024

Foreign body aspiration – the most important rules for prehospital care

Up to the age of 3-4 years, children are more likely to explore objects with their mouths than with their hands. Objects can be swallowed, although the distinction between ingestion and aspiration is not always clear. If a foreign body in the mouth causes a very violent cough, the foreign body has usually been inhaled. However, aspiration of food (especially nuts and raw vegetables) can also occur during meals, especially if people are playing at the same time or the situation is very restless.

Misinformation through video

Fortunately, life-threatening situations directly related to the event are very rare. In such cases, the recommendations of the ERC guidelines apply (see Figure [1]). If coughing is ineffective, back blows or the Heimlich maneuver (abdominal compressions) are indicated, depending on body size. If the child is unconscious, the airway must be opened and carefully inspected – preferably with a laryngoscope and Magill forceps – and ventilation established (see blog post “Ventilation problems – spoon with light“). In the event of respiratory-circulatory arrest, resuscitation measures must be carried out with cardiac massage. If there is no improvement, the child is intubated endotracheally. If adequate ventilation is not possible with a correctly positioned tube, an attempt must be made to move the foreign body into a main bronchus by inserting the tube at a specific depth and to ventilate the child via the free lung after retracting the tube into the trachea (tube size and depth can be read from the pedNFL in seconds). NOTE: If stabilization cannot be achieved in this way, the child must be taken as quickly as possible to a hospital where the foreign body can be retrieved endoscopically using resuscitation measures!Figure 1:

The children usually feel much better after this striking coughing episode. However, this does not mean that they have coughed up the foreign body. Often it has only penetrated deeper into the lungs and – initially – causes few or even no symptoms [2]. However, a life-threatening displacement of the foreign body into the trachea can occur in the course of the procedure, so that a presentation in a competent clinic must be made in any case. In addition, foreign bodies remaining in the lungs pose a considerable long-term threat! NOTE: A bronchoscopy must be performed after every typical event and every suspected foreign body aspiration For more information, the guideline for foreign body aspirations and ingestions in children is currently being revised and will be updated in mid-2024(https://register.awmf.org/de/leitlinien/detail/001-031).

Literature:

  1. Van de Voorde P, Turner NM, Djakow J et al. European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation 2021; 161: 327-387, DOI: 10.1016/j.resuscitation.2021.02.015.
  2. Kaufmann J, Laschat M, Frick U et al. Determining the probability of a foreign body aspiration from history, symptoms and clinical findings in children. Br J Anaesth 2017; 118: 626-627, DOI: 10.1093/bja/aex023

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