Out‑of‑Hospital Cardiac Arrest from Foreign Body Airway Obstruction: A Population‑Based Study in Victoria, Australia

Foreign body airway obstruction (FBAO) is a time-critical emergency that can rapidly progress to cardiac arrest. Despite its clinical significance, contemporary epidemiological data describing out-of-hospital cardiac arrest (OHCA) precipitated by FBAO remain limited.

We conducted a retrospective analysis of all emergency medical service (EMS)-attended OHCA cases in Victoria, Australia (1 July 2020-30 June 2024) recorded in the Victorian Ambulance Cardiac Arrest Registry. All arrests precipitated by FBAO were included. We extracted data to characterise the sequence, type, and effectiveness of interventions used to relieve obstruction.

Of 29,684 OHCAs, 223 (0.8%) were due to FBAO. Median age was 77 years, and most events occurred in private residences (56%) or residential care homes (30%). Sixteen percent of patients received no bystander intervention. The most common EMS interventions were CPR (n=171, 84.2%) followed by use of Magill's forceps (n=119, 58.6%) and suction (n=111, 54.7%). Magill's forceps and intubation were the most effective techniques for establishing ventilation (each with 73% success when used), whereas laryngeal mask airway devices were frequently used (n=67, 35%) but rarely effective (7%). FBAO removal was achieved in 165 (74.0) patients; whilst 107 (48.0%) achieved return of spontaneous circulation, only 8 (3.6%) survived to hospital discharge. Among patients aged over 65 years (n=165), there were no survivors.

OHCA due to FBAO is associated with extremely poor survival, particularly in patients aged over 65 years. The findings emphasise the critical importance of prompt bystander intervention and the need for evidence-informed EMS interventions and assessment of futility.