Abstract 4142501: Bystander Abdominal Thrusts and Back Blows were Associated with Favorable Neurological Outcomes in Patients with Foreign Body Airway Obstruction

Background: Foreign body airway obstruction (FBAO) represents a major public health challenge in developed countries with aging populations. We previously reported that bystander FBAO interventions were associated with about a two-fold increase in favorable neurological outcomes; however, the impact of each different type of intervention on patient outcomes remains unknown. Hypothesis: We hypothesize that abdominal thrusts and back blows are associated with favorable neurological outcomes in patients with FBAO compared to no bystander intervention. Methods: The MOCHI (Multi-center Observational CHoking Investigation) registry is a prospective, multi-center study conducted in Japan, focusing on patients with FBAO in emergency departments. From April 2020 to March 2023, 25 hospitals, including eight university hospitals, participated. For this analysis, we included only adult patients who were over 18 years. Data were collected electronically, documenting demographics, FBAO specifics, bystander characteristics, intervention types, and 30-day outcomes. Primary outcomes were favorable neurological outcome defined as Cerebral Performance Category 1 or 2 and survival outcome at 30 days. Inverse probability of treatment weighting (IPTW) and logistic regression were used to adjust for potential confounders. Results: Among 407 patients, 24, 76, and 175 received abdominal thrusts, back blows, and no bystander interventions, respectively, while the rest received other interventions. Median age was 81, with equal male-to-female ratio. FBAO incidents mainly occurred at home (57%). Patients with abdominal thrusts or back blows had higher rates of favorable neurological outcome than those without bystander interventions (37% vs. 15%, p = 0.01 for abdominal thrusts; 32% vs. 15%, p = 0.004 for back blows). IPTW analysis showed that abdominal thrusts and back blows groups had higher rates of favorable neurological outcome compared to the no-bystander intervention group (38% vs. 15%, p = 0.038 for abdominal thrusts; 31% vs. 16%, p = 0.013 for back blows). Cox proportional models showed that the back blow was independently associated with survival (adjusted Hazard Ratio [HR] 0.52, 95% CI, 0.35–0.78); however, abdominal thrusts was not independently associated with survival (adjusted HR 0.73, 95% CI, 0.40–1.35). Conclusion: Bystander abdominal thrusts and back blows were associated with favorable neurological outcomes in FBAO compared with no bystander intervention.