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Kudos to WSJ for giving thorough look at ‘Heimlich alternative’ devices for choking victims

PHOTO: SCIENCE PHOTO LIBRARY/GETTY IMAGES

LifeVac and Dechoker pose alternative to abdominal thrusts

The Ache: Nearly 5,000 people a year die from choking in the U.S., according to the nonprofit National Safety Council.

The Claim: Two new easy-to-use devices work like plungers to suck out obstructions in the airway, providing another option if standard treatment—such as abdominal thrusts developed in 1974 by Henry Heimlich—fail to clear the airway, say the companies who sell them.

The Verdict: A recently published laboratory study showed the LifeVac, from LifeVac LLC of Springfield Gardens, N.Y., dislodged simulated obstructions. So far there haven’t been any scientific publications detailing lives saved with the LifeVac or another device, from Dechoker LLC, of Salisbury, N.C.

Both the Dechoker, $89.95, and the LifeVac, $69.95, have a plastic mask that provides a seal over the mouth and nose while suction is provided. The Dechoker looks like a large syringe, while the LifeVac’s plunger is shaped like a small accordion. In both devices, one-way valves allow air to only travel out of the mask and not into it, which avoids pushing the object deeper in, says LifeVac Chief Executive Arthur Lih.
While the devices “theoretically” could work, there isn’t enough evidence for them, says New Orleans physician Jay Kaplan, president of the American College of Emergency Physicians. There are a number of potential pitfalls, including whether a panicking choking victim would let a rescuer put a mask on the mouth, he adds.

The Dechoker looks like a large syringe. ENLARGE
The Dechoker looks like a large syringe. PHOTO: DECHOKER
Early adopters of the devices include people with chronic diseases at high risk for choking. “This is a very simple device which people can have on hand,” says Port Charlotte, Fla., neurologist William Holt. He says he recommends the LifeVac to his multiple-sclerosis patients, as the disease interferes with the muscular coordination involved in swallowing. Dr. Holt says he works as a volunteer adviser to LifeVac but has no financial link to the company.
Skeptics include Dr. Heimlich, now 96. Such a device may not be handy in the “unexpected instance that a person chokes,” Dr. Heimlich, a retired thoracic surgeon from Cincinnati, says in a statement released by his son, Phil Heimlich. “Any action that delays use of the Heimlich maneuver or complicates the rescue can be deadly.”

If a person is choking and isn’t able to cough out the obstruction, the American Heart Association recommends a rapid sequence of abdominal thrusts. If that doesn’t work, or if you can’t get your arms around the victim, due to obesity or pregnancy, another option is thrusting around the chest area, adds Clifton Callaway, chairman of the AHA’s Emergency Cardiovascular Care committee. The American Red Cross recommends using five back blows, followed by five abdominal thrusts, repeating as needed.

The LifeVac and the Dechoker are both intended to be used if standard rescue treatments fail, the companies say. One person can get the device while another person starts the Heimlich maneuver, suggests Sean Pittman, Dechoker’s director of strategic development.

 

The American Heart Association, which last updated its guidelines on choking rescue in 2010, looks for published reports in scientific journals that a technique has a record of successful uses before recommending it, the group says.

The Ache: Nearly 5,000 people a year die from choking in the U.S., according to the nonprofit National Safety Council.

The Claim: Two new easy-to-use devices work like plungers to suck out obstructions in the airway, providing another option if standard treatment—such as abdominal thrusts developed in 1974 by Henry Heimlich—fail to clear the airway, say the companies who sell them.

The Verdict: A recently published laboratory study showed the LifeVac, from LifeVac LLC of Springfield Gardens, N.Y., dislodged simulated obstructions. So far there haven’t been any scientific publications detailing lives saved with the LifeVac or another device, from Dechoker LLC, of Salisbury, N.C.

Both the Dechoker, $89.95, and the LifeVac, $69.95, have a plastic mask that provides a seal over the mouth and nose while suction is provided. The Dechoker looks like a large syringe, while the LifeVac’s plunger is shaped like a small accordion. In both devices, one-way valves allow air to only travel out of the mask and not into it, which avoids pushing the object deeper in, says LifeVac Chief Executive Arthur Lih.
While the devices “theoretically” could work, there isn’t enough evidence for them, says New Orleans physician Jay Kaplan, president of the American College of Emergency Physicians. There are a number of potential pitfalls, including whether a panicking choking victim would let a rescuer put a mask on the mouth, he adds.

The Dechoker looks like a large syringe.

 

The Dechoker looks like a large syringe. ENLARGE
The Dechoker looks like a large syringe. PHOTO: DECHOKER
Early adopters of the devices include people with chronic diseases at high risk for choking. “This is a very simple device which people can have on hand,” says Port Charlotte, Fla., neurologist William Holt. He says he recommends the LifeVac to his multiple-sclerosis patients, as the disease interferes with the muscular coordination involved in swallowing. Dr. Holt says he works as a volunteer adviser to LifeVac but has no financial link to the company.
Skeptics include Dr. Heimlich, now 96. Such a device may not be handy in the “unexpected instance that a person chokes,” Dr. Heimlich, a retired thoracic surgeon from Cincinnati, says in a statement released by his son, Phil Heimlich. “Any action that delays use of the Heimlich maneuver or complicates the rescue can be deadly.”

If a person is choking and isn’t able to cough out the obstruction, the American Heart Association recommends a rapid sequence of abdominal thrusts. If that doesn’t work, or if you can’t get your arms around the victim, due to obesity or pregnancy, another option is thrusting around the chest area, adds Clifton Callaway, chairman of the AHA’s Emergency Cardiovascular Care committee. The American Red Cross recommends using five back blows, followed by five abdominal thrusts, repeating as needed.

The LifeVac and the Dechoker are both intended to be used if standard rescue treatments fail, the companies say. One person can get the device while another person starts the Heimlich maneuver, suggests Sean Pittman, Dechoker’s director of strategic development.

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The American Heart Association, which last updated its guidelines on choking rescue in 2010, looks for published reports in scientific journals that a technique has a record of successful uses before recommending it, the group says.

A recently published study showed that the LifeVac dislodged simulated obstructions. ENLARGE
A recently published study showed that the LifeVac dislodged simulated obstructions. PHOTO: LIFEVAC
On the market less than two years, neither LifeVac nor Dechoker has published evidence of successful uses in humans. Two users have told Dechoker that the device successfully dislodged an obstruction, says Mr. Pittman. In a recent case of an elderly woman in Wales, the LifeVac removed an obstruction after standard treatments failed, says Mr. Lih. The company doesn’t yet have full details on the case, he adds.

In a study published online in March in the American Journal of Emergency Medicine, the LifeVac successfully removed test obstructions made of clay from the upper airway of a cadaver. “It worked 49 out of 50 times on the first try,” says study co-author Mimi Juliano, a Farmingdale, N.Y., speech pathologist who specializes in swallowing disorders. The one time the device failed on the first try, researchers didn’t have a good seal around the mouth, she says; it worked the second time.

Can’t get this picture 

A recently published study showed that the LifeVac dislodged simulated obstructions. ENLARGE
A recently published study showed that the LifeVac dislodged simulated obstructions. PHOTO: LIFEVAC

On the market less than two years, neither LifeVac nor Dechoker has published evidence of successful uses in humans. Two users have told Dechoker that the device successfully dislodged an obstruction, says Mr. Pittman. In a recent case of an elderly woman in Wales, the LifeVac removed an obstruction after standard treatments failed, says Mr. Lih. The company doesn’t yet have full details on the case, he adds.

In a study published online in March in the American Journal of Emergency Medicine, the LifeVac successfully removed test obstructions made of clay from the upper airway of a cadaver. “It worked 49 out of 50 times on the first try,” says study co-author Mimi Juliano, a Farmingdale, N.Y., speech pathologist who specializes in swallowing disorders. The one time the device failed on the first try, researchers didn’t have a good seal around the mouth, she says; it worked the second time.

Step-by-step guide to using the Dechoker.

Step-by-step guide to using the Dechoker. ENLARGE
Step-by-step guide to using the Dechoker. PHOTO: DECHOKER

Rating

5 Star

Can New Devices Match Heimlich to Stop Choking?

Our Review Summary

Close Up Of Woman Demonstrating Heimlich ManeuverThis is a story that looks at two devices that purport to be alternatives to the Heimlich maneuver for choking victims.

While the story doesn’t fully answer the question posed by its own headline, it makes an admirable presentation that is clear and balanced, checking off all of our criteria. In particular, the story establishes the cost and availability of the devices and interviews several independent sources.

However, since the devices might be offered as an alternative to the Heimlich maneuver, some discussion on their ease-of-use would have been nice, but is missing from the discussion, as well as what kind of safety testing these devices do or do not have to undergo compared to other emergency medical devices.

 

Why This Matters

A widely accepted practice to help choking victims is the Heimlich maneuver. The article discusses two devices currently on the market that claim to provide backup options should the Heimlich maneuver fail. The devices have not been tested in people–except in cadavers–and may not be effective if used by untrained personnel.

Editor’s note: A change was made in the first sentence of Why This Matters. “The standard accepted practice…” now reads as “A widely accepted practice…” As a reader pointed out, there are several evidence-based approaches for choking first aid, including back blows and chest thrusts.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The article provides prices on both devices:

Both the Dechoker, $89.95, and the LifeVac, $69.95, have a plastic mask that provides a seal over the mouth and nose while suction is provided.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The article carefully reminds readers that both devices need further testing. Under “Verdict,” the article reads

So far there haven’t been any scientific publications detailing lives saved with the LifeVac or another device, from Dechoker LLC, of Salisbury, N.C.

In particular, we understand from the article that

On the market less than two years, neither LifeVac nor Dechoker has published evidence of successful uses in humans.

The successes of LifeVac have been studied only in cadavers where success was observed “49 out of 50 times.”

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The article explains possible harms from using the devices by soliciting opinions from the Heimlichs, the namesake of the famous Heimlich maneuver:

“Any action that delays use of the Heimlich maneuver or complicates the rescue can be deadly.”

To balance this perspective, the article also discusses the use of these devices as a backup to other standard procedures:

The LifeVac and the Dechoker are both intended to be used if standard rescue treatments fail, the companies say. One person can get the device while another person starts the Heimlich maneuver, suggests Sean Pittman, Dechoker’s director of strategic development.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The article displays a solid grasp of the quality of the evidence. In particular, the reader is made aware that the LifeVac device has only been tested in cadavers; neither device has been rigorously tested in humans. The few successful cases reported in humans are so far anecdotal in nature.

We do wish the story had explored what kind of safety testing these devices must undergo before going on store shelves. Considering the lack of evidence showing they work, are they held to a lower standard than other emergency medical devices?

Does the story commit disease-mongering?

Satisfactory

The statistic on choking is reported in a factual manner without any disease mongering:

Nearly 5,000 people a year die from choking in the U.S., according to the nonprofit National Safety Council.

It would have been even more helpful if the story had explored whether people who died from choking received the Heimlich maneuver and if so, was it inadequate? That would give us a better sense as to the need for this device. (We realize that’s a lot to ask!)

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The article does an excellent job presenting opinions from both people involved in the companies and independent stakeholders outside of the companies.  These independent sources increased the impartiality of the news story.

Does the story compare the new approach with existing alternatives?

Satisfactory

The standard treatment for choking is the Heimlich maneuver. Representatives from Dechoker want to present the device as a fail-safe to the Heimlich maneuver.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

It sounds like the devices are already available:

On the market less than two years, neither LifeVac nor Dechoker has published evidence of successful uses in humans.

Does the story establish the true novelty of the approach?

Satisfactory

It seems like one particular novelty of the device is the demographic it targets:

Early adopters of the devices include people with chronic diseases at high risk for choking.

Does the story appear to rely solely or largely on a news release?

Satisfactory

It does not appear that the article solely relies on a news release as several independent sources were interviewed.

Total Score: 10 of 10 Satisfactory

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