Chapter 207: Airway Foreign Body Removal

INTRODUCTION

The presence of an airway foreign body is a common cause of morbidity and mortality in children, especially those younger than 3 years of age. Children use their mouths to explore their surroundings. Over 70% of foreign body aspirations occur in children.^1,2 Boys are twice as likely as girls to experience an airway foreign body.³ The incidence of airway foreign bodies has decreased over the past four decades due to public awareness campaigns. The mortality rate following foreign body aspiration is estimated to be 1% to 2%. This rate has remained fairly constant since the beginning of the 20th century. The mortality rate was approximately 24% prior to the advent of endoscopic techniques for airway foreign body removal.⁴ In the year 2000, ingestion or aspiration of a foreign body resulted in more than 17,000 Emergency Department (ED) visits in the United States.⁵ The death rate has remained at approximately 4000 deaths per year for the past two decades.^6-8 The most serious and life-threatening scenario is complete airway obstruction. This usually occurs at the level of the larynx or trachea.

Common airway foreign bodies are food items, coins, jewelry, and toys. Food objects have been associated with 41% of deaths and nonfood substances have been associated with 59% of reported deaths.⁵ The leading causes of food foreign body airway obstruction are hard candy and nuts.^5,9 Other globular objects such as hot dogs, soft candies, chewing gum, and grapes are commonly aspirated food objects.¹⁰ Coins and toys are commonly aspirated nonfood objects.^5,9,11-13 Rubber balloons, jewelry, and toys are the most commonly aspirated nonfood objects.^12,14 Vegetable matter accounts for 55% to 95% of airway foreign bodies, with nuts accounting for around 39% alone.¹⁵

Parents and caregivers should be educated and aware of the types of food and objects that pose a choking risk for children.^12,16-18 They should become familiar with the methods to reduce this risk. All parents and caregivers should learn the techniques to treat a choking child. Basic life support classes are often available free or at a minimal cost at hospitals, churches, and community centers.

The management of airway foreign bodies in the hospital requires an emergency specialist capable of managing acute airway compromise. Airway foreign bodies located in the larynx, trachea, or pulmonary tree require an Otolaryngologist, Pulmonologist, or other qualified specialist with experience in airway endoscopy and the availability of that equipment in the Operating Room or an Intensive Care Unit. Cases involving children require specialized expertise and equipment for pediatric airway endoscopy. The ED must manage the airway foreign body if the airway becomes unstable or if the consultants are not immediately available. The morbidity and mortality associated with airway foreign body retrieval have greatly declined due to the development of safe endoscopic techniques, rod-lens ...