Dear Editor,
Foreign body airway obstruction (FBAO), or choking, is among the world’s leading causes of accidental death [
1]. Choking is commonly witnessed, and with rapid bystander intervention, fatal or neurologically unfavorable outcomes can be prevented [
2].
The current American Heart Association and European Resuscitation Council guidelines are unanimous in their recommended approach to choking incidents, which depends on the severity of obstruction [
3,
4]. Mild, partial FBAO cases should be managed solely by encouraging the victim to cough. Severe choking in conscious victims, who cannot cough effectively or cannot cough at all, requires repeated cycles of back blows and abdominal thrusts until the object is expelled or the victim becomes unresponsive. For an unconscious victim, the rescuer should immediately start cardiopulmonary resuscitation (CPR) [
3,
4].
In recent years, manual suction-based airway clearance devices, which generate transient negative pressure to remove foreign objects, have been increasingly promoted through mass media as must-have life-saving tools for managing FBAO. Because evidence regarding the performance of such instruments is scarce, studies on the benefits and harms of their use have been encouraged [
5].
The study by Metličar et al. [
6], published in
Clinical and Experimental Emergency Medicine, aimed to provide an overview of foreign bodies that were removed with an anti-choking suction device LifeVac (LifeVac LLC). The observations are based on FBAO incident data that were self-reported by device users through online or paper forms completed at the manufacturer’s request. A methodological constraint, acknowledged by the authors, was that the database included solely successful cases of LifeVac application collected from a geographically unrestricted population. This limited the epidemiological insights of the study and prevented meaningful inference about the device’s effectiveness. Nonetheless, the study indirectly offers important knowledge regarding public preferences for using the device during real emergencies, warranting recognition and transparent discussion.
According to Metličar et al. [
6], the percentage of rescuers who administered back blows or abdominal thrusts before using LifeVac was 79%. Consequently, in more than one-fifth of choking cases, the device was applied straight away, neglecting the currently recommended first aid measures [
3,
4]. For those cases where back blows or abdominal thrusts were attempted, the exact content, quality, and duration of interventions before using LifeVac are unknown. In addition, the study found that the prevalence of complete airway obstruction was approximately 48%. This implies that in a number of cases LifeVac may have been used for partial airway obstruction, including mild cases in which victims were able to actively cough—the scenario where the implementation of any maneuvers is unadvisable, and the only recommended action involves encouraging the victim to clear the airway themselves by coughing while observing for signs of severe airway obstruction [
3,
4].
The effectiveness and safety of suction-based airway clearance devices have not been established. Given the lack of evidence, major professional resuscitation societies, including the American Heart Association, the European Resuscitation Council, and the International Liaison Committee on Resuscitation, do not recommend their use [
3,
4,
7]. Although Metličar et al. [
6] noted that the use of an anti-choking suction device should be a last resort in cases where guideline-based interventions fail to manage the obstruction, the findings above suggest a contrasting pattern in public behavior: when LifeVac is available, many rescuers attempt to use it instead of performing the recommended life-saving maneuvers.
An example can be found online (presented as an illustrative anecdote, recognizing that the limited information available prevents drawing firm conclusions). In June 2024, multiple media outlets reported a story of a police officer saving an 8-year-old choking victim using LifeVac. News video reports included dramatic moments of the incident caught on the officer’s body cam [
8]. In the beginning (body cam timestamped at 20:02:02; visible in the news video at 00:14), the recording shows the victim unconscious and exhibiting agonal breaths—the diagnostic criteria of cardiac arrest. Based on the current pediatric life support guidelines [
9,
10], these presentations constitute an indication for the immediate initiation of CPR, involving chest compressions that generate high airway pressures required for removing a foreign body [
11]. However, the video shows that rather than starting CPR, the officer picks up the boy and rushes to a patrol car to retrieve LifeVac. The next segment of the recording demonstrates continued attempts at LifeVac suction “pulls” on the victim (the last attempt shown timestamped at 20:04:17; visible in the news video at 1:18). While more than 2 minutes have passed, no CPR is provided at this point. Fortunately, the outcome of this specific case was positive—the victim survived. One could argue that success justifies the means, but the question naturally arises: how many lives may be lost when choking victims do not receive guideline-recommended first aid because rescuers rely on LifeVac or similar devices whose effectiveness remains unproven?
Choking is an extremely time-sensitive emergency, where every minute of continued obstruction increases the risk of a vegetative state or death from anoxia [
1]. The preference for nonevidence-based methods may delay or prevent recommended first aid interventions, potentially leading to negative outcomes. However, such unfortunate cases are concealed. The published experience with suction-based airway clearance devices is biased, consisting primarily of manufacturer-supplied reports from survivors, whereas fatal cases remain unreported. Manufacturers should recognize the potential public health impact and their responsibility when promoting and commercializing suction-based airway clearance devices before sufficient, sound evidence confirming their effectiveness becomes available. Widespread, coordinated efforts are needed to enhance the coverage of laypeople with conventional first aid training for choking and to improve public awareness of the risks associated with overreliance on suction-based devices at the expense of the recommended life-saving techniques.
NOTES
-
Conflicts of interest
The author has no conflicts of interest to declare.
-
Funding
The author received no financial support for this study.
-
Data availability
Data sharing is not applicable as no new data were created or analyzed in this study.
REFERENCES
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Citations
Citations to this article as recorded by
- Real‐World Deployment and Regulatory Actions Concerning Suction‐Based Anti‐Choking Devices
Alexei A. Birkun
Academic Emergency Medicine.2026;[Epub] CrossRef - Dispositivos de succión para el atragantamiento: revisión crítica de la evidencia y consideraciones en pediatría
Ignacio Manrique Martínez, Sara Pons Morales
Pediatría Integral.2026; : 279e1. CrossRef
