Characteristics and Outcomes of Emergency Transferred Patients with Foreign Body Airway Obstruction in Tokyo, Japan.

INTRODUCTION: Foreign body airway obstruction (FBAO) is a life-threatening emergency, and the prognosis of patients with FBAO is greatly affected by the prehospital process. There are only a few large-scale studies analyzing prehospital process databases of the fire department. STUDY OBJECTIVE: The aim of this study was to investigate whether characteristics of patients with FBAO were associated with prehospital factors and outcomes. METHODS: In this retrospective observational study, patients transferred to the hospital by the Tokyo, Japan Fire Department for FBAO from 2017 through 2019 were included. The association between neurologically favorable survival among the characteristics of patients with FBAO and prehospital factors affecting the outcomes was evaluated. RESULTS: Of the 2,429,175 patients, 3,807 (0.2%) patients had FBAO. The highest number of FBAO cases was 99 (2.6%), which occurred on January 1 (New Year's Day), followed by 40 cases (1.1%) on January 2, and 28 cases (0.7%) on January 3. The number of patients who experienced out-of-hospital cardiac arrest (OHCA) caused by FBAO was 1,644 (43.2%). Comparing the OHCA and non-OHCA groups, there were significant differences in age, sex, time spent at the site, and distance between the site and hospital. Cardiac arrest was significantly lower in infants after FBAO (P < .001). In total, 98.2% of patients who did not have return of spontaneous circulation (ROSC) before hospital arrival died within 30 days, a significantly higher mortality rate than that in patients who had ROSC (98.2% versus 65.8%; P < .001). CONCLUSIONS: Among patients who did not have ROSC following FBAO upon arrival at the hospital, 98.2% died within 30 days. Thus, it is important to remove foreign bodies promptly and provide sufficient ventilation to the patient at the scene to increase the potential for ROSC. Further, more precautions should be exercised to prevent FBAO at the beginning of the year.

Food choking incidents in the hospital: Incidents, characteristics, effectiveness of interventions, and mortality and morbidity outcomes.

AIM: Foreign body airway obstruction (FBAO) due to food can occur wherever people eat, including in hospitals. We characterized in-hospital FBAO incidents and their outcomes. METHODS: We searched the Japan Council for Quality Health Care nationwide in-hospital adverse events database for relevant events from 1,549 institutions. We included all patients with FBAO incidents due to food in the hospital from January 2010 to June 2021 and collected data on the characteristics, interventions, and outcomes. FBAO from non-food materials were excluded. Our primary outcomes were mortality and morbidity from FBAO incidents. RESULTS: We identified 300 patients who had a FBAO incident from food. The most common age group was 80-89 years old (32.3%, n = 97/300). One-half (50.0%, n = 150/300) were witnessed events. Suction was the most common first intervention (31.3%, n = 94/300) and resulted in successful removal of foreign body in 17.0% of cases (n = 16/94). Back blows (16.0%, n = 48/300) and abdominal thrusts (8.1%, n = 24/300) were less frequently performed as the first intervention and the success rates were 10.4% (n = 5/48) and 20.8% (n = 5/24), respectively. About one-third of the patients (31%, n = 93/300) died and 26.7% (n = 80/300) had a high potential of residual disability from these incidents. CONCLUSION: FBAO from food in the hospital is an uncommon but life-threatening event. The majority of patients who suffered from in-hospital FBAO incidents did not receive effective interventions initially and many of them died or suffered residual disability.

Pain intensity during the first 7 days following the application of light and heavy continuous forces.

The purpose of the present study was to determine whether a force of 20 cN can be biologically active for tooth movement and to examine the pain intensity during the application of light (20 cN) or heavy (200 cN) continuous forces for 7 days. In the first experiment, a force of 20 cN was applied to eight canines in five volunteers. The mean tooth movement during 10 weeks was 2.4 mm. In the second experiment, two forces of 20 or 200 cN were applied to maxillary premolars in 12 male subjects (aged 24-31 years) to measure pain intensity for 7 days. Spontaneous and biting pain were recorded every 2-4 hours on a 100 mm visual analogue scale (VAS). Wilcoxon signed-rank test was used for statistical analysis. Comparing the VAS score at force initiation with the other time points, there was no significant difference in spontaneous pain for either group, or in biting pain for the light-force group. However, biting pain in the heavy-force group during the time period from 6 to 156 hours was significantly (P < 0.05) greater than that at force initiation. Comparing the VAS scores between the light- and heavy-force group, VAS scores for biting pain in the heavy-force group during the time period from 8 to 100 hours was significantly (P < 0.05) greater than that in the light-force group. A force of 20 cN can move teeth, but pain intensity while biting may be greater approximately 8 hours to 5 days following the application of heavy continuous force compared with light force.