Comparison of foreign body airway obstruction interventions among laypersons: A simulation-based, crossover, randomized controlled trial.

Background: Foreign body airway obstruction (FBAO) is a life-threatening emergency where rapid bystander intervention is essential. Suction-based airway clearance devices like Dechoker (DC) and LifeVac (LV) are marketed alternatives to abdominal thrusts (AT), but their efficacy among laypersons is unclear. We aimed to determine which intervention (AT, DC or LV) has the greatest efficacy for FBAO relief by laypersons. Methods: We conducted a simulation-based, crossover, randomized controlled trial. Adult laypersons received standardized in-person instruction on AT, DC, and LV, then responded to three simulated FBAO events on an adult mannequin. A mixed-effects logistic regression model estimated the odds ratios (OR) of FBAO relief at one minute (primary outcome) and four minutes (secondary), adjusted for carryover effects. Skill retention was evaluated 90-120 days later without retraining. Results: Of 139 participants, 132 were eligible and randomized. Median age was 39 years (IQR: 26-56), and 66 % were female. At one minute, FBAO relief occurred in 86 % (LV), 62 % (DC), and 49 % (AT) of cases. LV had greater odds of relief than AT (OR = 12.4 [95 %CI 5.6-27.2]) and DC (OR = 5.8 [95 % CI 2.8-12.1]). Compared with AT, DC also had greater odds of relief (OR = 2.1 [95 %CI 1.2-3.8]). At four minutes, results were similar. During follow-up testing, LV remained superior to AT (OR = 97.7 [95 %CI 6.3-1549]), while DC did not. Conclusion: After brief training, LifeVac was superior to abdominal thrusts and Dechoker for simulated FBAO relief among laypersons. Research evaluating LifeVac's safety and effectiveness in a controlled clinical setting is now needed. Trial registration: ClinicalTrials.gov Identifier: NCT06227234.