Dechoker medical device could end deaths by choking | Hacker News Reader

Dechoker medical device could end deaths by choking

insiderlouisville.com

215 pointsalvinktai104 comments

A comment on the article mentions a competitor at http://lifevac.net:

"There is another version of this type of device that has been around (FDA approved) for a couple of years now. It's called LifeVac and it has been adopted by several fire departments, schools, skilled nursing facilities and families all across the eastern seaboard as well Europe and Canada. Only costs $69.95 and even that number can come down with different promotions that are offered."

Are you saying the article was lying? "There is nothing like Dechoker on the market." ;-)

Looks like the earliest mention I can find of LifeVac is May 15, 2014, while Dechoker is from 2011. I wonder if this is a case of "imitation is the sincerest form of flattery", or whether they were independent ideas?

Worth noting that the Dechoker covers a wider age range. LifeVac says not recommended under 40 pounds (probably age 3-5), Dechoker goes down to 6 months with the toddler version.

The instruction diagram is great:

https://lifevac.net/wp-content/uploads/easy-as-place-push-pu...

...just like unclogging a toilet with a plunger!

This lifevac is a total joke! No way the tongue and cheeks don't get in the way. So, really we are supposed to plunge down on someone's head and hope a toilet plunger works. Is that legit, seriously

My wife is Japanese, and she said that in Japan lots of old people choke on mochi (a sticky sweet made from rice). From what she says, when this happens - the best thing to use is a vacuum cleaner. I also remember a scene from Tampopo[0] where this takes place. Sounds pretty scary and odd, but probably not an entire myth[1,2]

I wonder how effective this is, and what are the risks to the lungs after whatever's stuck gets dislodged.

I guess when you're choking, you'd take that risk if all else fails (if you or someone around you can act fast enough to pull a vacuum cleaner...)

[0] http://www.imdb.com/title/tt0092048/

[1] http://www.accessj.com/2012/01/choking-on-mochi-grab-vacuum....

[2] http://www.japantimes.co.jp/news/2001/01/07/national/daughte...

Nice, I've never heard of this "dechoking" method. I'm guessing you need one of these types of vacuums: http://www.tipa.eu/fotocache/bigorig/08850298.jpg and then you put your mouth around it?

I guess it won't exactly work with a "standing" vacuum cleaner(like [0]), but in recent years, most vacuum cleaners I see -- like the one you linked to -- have a long hose, and you can definitely fit it in someone's mouth. (you remove the big attachment at the end)

On the cost side, you can probably get a nice vacuum cleaner for $150 :)

I'm still wondering about how effective vs. how risky this technique might be though

[0] http://www.amazon.com/Rowenta-Lightweight-Cordless-Cyclonic-...

The scene in question from Tampopo:

[0] https://www.youtube.com/watch?v=83KgeYls7iM

To the later reply, well, in the movie they actually use a normal household vacuum.

> the instructor told him frankly that the victim would die. He researched the subject thoroughly and found that there was absolutely no other solution to choking besides the Heimlich maneuver

maybe I've seen too many movies, but what about the old knife and ball pen Tracheotomy?

Do you really trust any significant number of people to do that without killing the person?

I would assume a ship with a crew of any significant size would have someone on board who is capable of performing a cricothyrotomy.

On top of that: If it's pretty much a guarantee I'll die anyway, I'd rather them take the chance. Heavily dependent on the situation though

I've always been rather skeptical about how well that would actually work in practice. But even if it does, presumably the person still needs immediate medical care, as having a hole cut open in their throat is still a pretty serious condition. If you're 100 miles out at sea, you're probably not going to do so well trying to breath through a makeshift tube from a hole in your throat.

I remember hearing a story of it being used a few times during flights. I guess it does work, and having a hole in your throat is not that bad, there are no arteries or much blood flow at all in there. Of course, I would still vastly prefer a dechoker! (assuming it works well)

There's no bloodflow if you do it exactly right - just a half-inch to either side is a different story!

A flight is a much more controlled environment, and one that will have immediate access to medical personnel the moment they touch down. 100 miles out at sea is not exactly a controlled environment, and access to medical personnel is not a matter of a short wait.

Father Mulcahay certainly had no trouble performing one with no medical training, just a doctor on a radio to walk him through it. Must be pretty easy.

That was a great episode.

Not only do you have to know where to puncture, you also have to make sure you puncture below the obstruction.

The problem with the surgical cric or any other method is that it needs to be lower than the object lodged, which shouldn't be too difficult most of the time but runs the risk of being a futile procedure.

Personally as a doctor I'm surprised they are teaching the heimlich, it's an outdated procedure with limited success, in ANZ first aid you're meant to slap on the back a bunch of times before going for physical removal

That's interesting -- my understanding is that Heimlich was explicitly intended to supersede the "slap on the back" technique.

You can thank good marketing for that.

According to Roger White MD of the Mayo Clinic and American Heart Association (AHA), "There was never any science here. Heimlich overpowered science all along the way with his slick tactics and intimidation, and everyone, including us at the AHA, caved in."[0]

0. https://en.wikipedia.org/wiki/Abdominal_thrusts#History

Fascinating! I had no idea this was the least bit controversial. Looks like Dr. Heimlich's own son threw him under the bus.

It always seemed to me that pounding someone on the back was as likely to force the obstruction farther into the trachea as it was to cause it to be expelled. After all, the victim is presumably trying to breathe, so dislodging the object without a strong upward thrust seems like a bad idea. Guess that's not the case.

With something obstructing their airway, I would have assumed they were trying to cough. Inhaling a tiny drop of spit can be enough to give me serious breathing problems, not because the spit does anything but because I have to cough so much afterwards.

Radiolab has a good episode on Dr. Heimlich: http://www.radiolab.org/story/heimlichs-maneuver/

Some googling (https://scholar.google.com/scholar?as_ylo=2011&q=dechoker&hl...) suggests there are no trials on the Dechoker yet. While that makes sense (realistic choking must be hard to induce experimentally, and any sort of experiment in the wild suffers from choking being rare), it does make me wonder how well it works.

It seems like if they don't have enough pressure in their lungs to expel the bite of ham sandwich, you wouldn't necessarily be able to suck it out with this device. On the other hand, I have a hard time blowing up those skinny balloons for balloon animals, but the pump thing they sell with them does it like a champ.

I'm not a doctor, but I imagine that using this device on someone without any air in their lungs might cause some sort of bleeding or abrasion in the lung tissue. Of course, if I'm choking I ccould care less...

...I'm terrified of choking, fwiw.

Their lungs are cheerfully cranking out carbon dioxide for the chance to do it again, so running out of residual volume or pulling nitrogen into gas has a lot of give. So you're the one with the strong negative response when people suggest hitting an exercise heart rate and recovering with solid food (root vegetables,) eh?

I doubt that you can completely deflate your lungs by exhaling; even if you try your hardest to exhale as deeply as you can. There would always be some air in the lungs so that the pressure difference generated by this device would almost certainly be enough to pop the blockage out of your trachea.

That's exactly right, something called Residual Volume (https://en.wikipedia.org/wiki/Lung_volumes#Values)

> On the other hand, I have a hard time blowing up those skinny balloons for balloon animals, but the pump thing they sell with them does it like a champ.

I think this is the real issue. Your lungs simply aren't very strong.

Even pro-athletes who we would normally associate with respiratory fitness, like runners and swimmers, have more capacity and efficiency then they do strength.

You'd equip half a city's ambulances with the devices, and track whether use of the Dechoker reduced tracheotomy rates.

A further complication is that the Dechoker would probably only work for solid objects, so emergency responders would have to determine the nature of the airway obstruction before deciding whether to use the Dechoker, or some other method (i.e., another suction device to remove semisolid debris like vomit). So you'd additionally have to track what the nature of the obstruction was and exclude cases where the Dechoker was applied inappropriately, or where the Dechoker was not used and it could have been.

Please note the small text on this page that says: "There is no guarantee this device will remove debris from the airway."

http://www.dechoker.com/pages/dechoker-usage-instructions

It is a 510K-exempt Class I medical device, according to the FDA. So its manufacturer has registered with the FDA but there is no FDA approval of its claim of being able to dislodge objects from a patient's airway. Nor is any data provided to demonstrate that it is at all effective.

There is no guarantee this device will remove debris from the airway.

That's somewhat of a "duh!" but I guess it's there just for legal reasons.

I just had a CPR class this week (baby due 11/30) and was thinking along these lines - isn't there another way.

Side note for some of the other comments - there are multiple ways to apply pressure to the thoracic cavity in order to express something lodged in the throat. If the person is large and you cannot wrap your arms around them, have them stand with their back against the wall and you thrust from the front just below the diaphram.

The goal of CPR is to resuscitate an individual who is not breathing. Whether the individual sustains other injuries through the course of being resuscitated does not matter. Better to be alive and injured than dead!

Indeed, you would be surprised by how often individuals suffer minor rib damage while being resuscitated.

It's a clever idea, but is the vision for this to have one hanging on the wall in a vast number of public places? It says there are 160,000 choking deaths worldwide annually. Presumably the Heimlich maneuver would have worked on some number of those. What is the marginal number of lives saved and at what cost?

The Heimlich manoeuvre worked on none of them, because they died. It might have been possible to prevent some of those deaths with wider or more effective provision, but that would also have costs.

I'm thinking that there is quite a bit of cost saved by posting a sheet of paper explaining the Heimlich maneuver instead of installing one of these devices. Give out free smoke detectors with the saved money.

If saving thousands of lives was that easy, someone would probably have already done it.

Edit: Not saying it couldn't help, but I don't think it's reasonable to assume most of those lives could be saved by putting some posters up unless you have some evidence.

Just because they died doesn't mean someone:

1) Did the Heimlich manoeuvre

2) Performed it properly

3) Continued proper behaviour after the Heimlich manoeuvre failed

There is a good chance the people who died were alone, that everyone around them panicked and froze up, or that nobody realized the person was in danger (people who choke are actually more likely to leave the room than try to tell someone). People often don't call 911 until it's too late.

I do see the OP's point that potentially education and teaching of what to actually do in these scenarios would be more effective than buying a vast number of these devices. I took a first aid course and I can say that while the majority of people know what the Heimlich manoeuvre is, I don't believe they'd behave properly in a chocking situation.

That said, I think these should definitely be put to trial runs to find out :)

My point is that I don't think that's a problem that can be solved with a few posters. It doesn't matter if the deaths could have technically been prevented with the Heimlich manoeuvre unless there's a cheap and practical way to get people to perform it properly.

So you think a problem that can't be solved with a picture of someone helping someone choking by grabbing them from behind and squeezing can be solved by having them find this gadget and figuring out how to use it? Curious.

I agree that I doubt posters would help. People need proper first aid training.

That said, the same logic applies to this device.

The device(s) in question are merely syringes with masks and a tube connected. If we assume that the average citizen in the developed world is OK with current levels of spending on public health with respect to emergency medical treatment, I doubt that a device such as this would necessitate concerns about "at what cost" any given number of lives are being saved.

In other words, dude its 150 bucks!

That's reasonable when deciding whether to get one for your house. Not so much when deciding whether it's generally a good value compared to other ways of saving lives. Then we're talking about ($150 x n)/(lives saved compared to the alternatives). Before you advocate it, maybe you should get an idea what n and the denominator are.

Every restaurant in NYC seems to have a defibrillator, so it could be doable.

What's the cost/benefit of those?

If you're the guy on the ground in cardiac arrest? Priceless.

Just checked Amazon - you can buy an AED for $959 minus $100 coupon. The recommended lifespan of an AED is 5-8 years, so for a smalltime operator you're looking at an amortized cost of $107-175 per year.

$10 per month is a rounding error in the operating budget of a public accomodation, and I don't see how you can possibly get upset about that. Let alone something like a ship that's multiple hours away from the closest possible medevac. A container ship likely burns more fuel than that in an hour of operation.

Won't someone please think of poor Maersk's quarterly profits? Or even worse, my Amazon crap might cost another $0.01 per tonne...

Even if you don't care that it's The Right Thing To Do, the cold truth is that if someone dies there's tons of expensive things that happen. If an employee dies there's insurance or comp to pay, there's the cost of hiring a replacement and so on, etc. And on a social level we lose their economic output and its effect on the aggregate economy.

Surely you understand that this reasoning must break down for some cost of AED. Presumably you have them in your home and office. Yes?

I saw someone die by choking when I used to work in a restaurant. This device would have been helpful. It also would've been helpful if anyone did anything right in an emergency.

There were 3 hostesses standing next to the phone. I was the bus boy.

After a manager told me to go all the way to the back and get another manager, I told him we should probably call 911 first.

The fire dept was across the street.

When I walked up to the phone, none of the hostesses had called 911, because no one told them to.

I called 911, but it was too late.

The man died.

That sounds awful. I'm sorry you had to be a party to such an event. Even if there were all these other older and more experienced people who should have acted intelligently, it sounds like you're still feeling guilty that you didn't do better. It's hard to realise that in most situations you do have to trust that in your instincts, instead of being able to think that all these supposedly more senior and responsible people actually have a clue... It shakes your faith in people and your sense of security. I'm sad that you had to go through that.

I love the idea, and it's just the kind of thing I'm paranoid enough to own, but the price is a bit up there. Hoping it comes down over time. But if I owned a restaurant, I'd be all over this, in a "Break Glass" kind of case.

That's the idea the article conveys, one of these should be next to every defibrillator (and defibs are seen in so many locations).

Not every restaurant has a defibrillator, but every restaurant may want one of these if it's really that effective.

And they should have it in the bathroom!

I've heard from an EMT friend that most choking deaths happen in restaurant bathrooms. Somebody gets up to excuse themselves to be polite and dies alone beside the dyson hand dryers.

I know if I were choking, I don't know how polite I would be to everyone around me

As a person with a medical condition that causes me to choke more often than a normal person would, I usually excuse myself because rectifying the situation typically involves vomiting.

I think the price point seems reasonable. It's a patented medical device without much competition. They have a target market that would spend the $150 without thinking twice.

They may eventually want to target individuals and those not in the high-risk area -- in which case the price will need to drop. However, for their current stage and what they're after it makes sense.

My guess is that as manufacturing costs lower and competitors realize the market, the price will eventually go down. Even offices, schools and other public places could benefit from having this also.

I read it as

    (Dechoker medical device could end deaths) by choking

when it really should be

    Dechoker medical device could end (deaths by choking)

English really needs better syntax.

This is known as an attachment ambiguity. The classical sentence is "The man saw the woman with the telescope."

I'm afraid it is not limited to English, and a very common phenomenon across many languages that use prepositional phrases. Languages that do avoid these usually have a complicated case system. Even there, we have other ambiguity-types that are also common in English, such as relative clauses, quantifiers, etc.

Ambiguity is a natural part of languages. It can be fun :-) http://languagelog.ldc.upenn.edu/nll/?p=4566

My favorite standard example sentence (of ambiguity, that is) is "we saw her duck".

Time flies like an arrow, but fruit flies like a banana.

Yesterday I shot an elephant in my pajamas. How he got in my pajamas, I'll never know.

That's an example of lexical ambiguity. You can have a lot of fun with lexical ambiguity, especially with polysemous words, e.g. "John and his driver's license expired last week." (This particular kind is an example of a zeugma.)

My brother once chocked with a piece of barbecue meat with farofa (a Brazilian mix of toasted cassava flour) in a restaurant. He was barely breathing, and could not swallow anything. We rushed to the hospital and they were able to save him.

Nobody new how to perform a Heimlich maneuver, and I don't know if it would have worked. I wonder if this device would have the suction strength to pull the obstruction in that situation, probably yes.

I took a CPR class several years ago before our first kid was born and within a week I couldn't have told you 100% how to perform a Heimlich. You drill it a couple times and are somehow expected to be able to perform it in an emergency, months (or in my case with a one-off class, years) later. I would attempt it if someone was choking with nobody better qualified around, but I always doubt that many people are going to be effective with this maneuver. I also couldn't imagine me doing much of anything on someone 200+ pounds (I'm all of 155). I'm really glad to hear there's an alternative.

That's one reason I really appreciate being a first-aider at work -- I get paid to do refreshers every year or two. The repeat classes usually contain at least one bit of information I've not heard before, but the biggest benefit is the opportunity to practise the techniques I've not had to use all year.

I took the full 3-day course for the first time this year, and the extra time for practicals was excellent.

Years later this incident I took a First AID, CPR and AED class. I have the same feeling, I don't think I would remember how to do everything now.

I'm curious to know the actual numbers (ie. force a human body can exert when attempting to breath in vs opposite pressure caused by this device or heimlich).

I performed heimlich on a roommate a long time ago when I was in college, but it turns out the pressure he was breathing in with was apparently more than the force I exerted trying to get him to push the object out. I simply helped dislodge the object, but it ended up going into his lungs rather than out.

Afterwards he told us he could feel the food (what was obstructing airway) in his lung.

Also I imagine in some circumstances (if the object is lodged in pretty tightly) the strength of the esophagus to withstand pressure would probably play a role. I could imagine if it's far enough down the esophagus, if the pressure required to pull it up is greater than the strength of the walls of the esophagus, then all you'll end up doing is collapsing the esophagus above the object that you're trying to dislodge.

And what happened after that?

He was fine as far as we all knew. He ended up leaving to go back home a few months after, and I wasn't close so we didn't stay in touch. I can't give a long-term prognosis, but I imagine the human body probably has mechanisms to deal with that sort of thing.

He didn't feel concerned enough about it to go to the hospital afterwards, and we were just college students so we didn't feel we had any reason to override his decision.

For future reference, go to hospital. The lungs are a one-way system and can't digest things - any object going in either comes out the same way or sits around. That lump of food will have rotted, and would be a significant infection risk.

Good to know. And btw, just in case anyone reading would get the wrong impression from my previous comment, I'm not saying I think the lungs could technically digest food.

Basically, in my experience, if I've ever inhaled water (never food) I generally find that there's several minutes (or hours depending on quantity of fluids) of intermittent coughing where I feel like my body is doing something to make it easier for me to expel the fluids.

In terms of food, depending on quantity I was imaginging over course of several days (weeks?) perhaps the body is able to expel the solids in similar fashion.

My roommate was not a very talkative person, but we did hang out quite a bit while he lived with us, and nothing ever appeared abnormal, and he never got sick so I'm guessing he just kept the messy details to himself.

> He researched the subject thoroughly and found that there was absolutely no other solution to choking besides the Heimlich maneuver. So he spent the past five years developing new technology to solve this problem.

Strange, I did my last first aid course about 5 years ago, and remember a few methods other than the Heimlich. The Heimlich has this weird PR where it seems that it's the only method that the US knows about. It's a bad method because it's not very good at applying pressure in the right places, and done by enthusiastic naifs it can break ribs (less of a problem) and do serious damage to internal organs (more of a problem).

Three alternatives to the 'one and only' Heimlich:

1) Start with short, hard, upward slaps on the victim's back, with the victim bent over if possible. This is more helpful in cases of partial choking

2) Get the victim on the ground on their side, and using both hands, push down on the side of their ribcage in short, sharp bursts. This uses the same 'pop a cork' mechanism as the Heimlich, but you get a lot more power and you won't damage internal organs (and are unlikely to break bones).

3) As a last resort, try and blow the obstruction further into the lungs. It will require surgery to remove, but that's better than dying.

What is your source for #2? The NHS (i.e., not the US) doesn't mention that technique.

http://www.nhs.uk/chq/pages/2301.aspx?categoryid=72

St John's Ambulance does first aid training here in Melbourne. They're basically a volunteer group who work alongside the professional paramedics; St John's generally does events like concerts and festivals, while the professionals do the usual emergency stuff. St John's also do a lot of first aid training here (the above examples come from a course of theirs).

The side chest compressions tend not to break ribs - normal CPR compressions do, but CPR needs to squish the heart - a smaller, tougher organ than the lungs. The heimlich also has to be done in an upright position, which makes it more awkward to do if you're not physically strong; it's all bicep strength, and you can't use your own weight to your advantage. Chest thrusts are also not complicated by a patient who is obese or pregnant.

Just googling around, found some research arguing for (normal) chest compressions over heimlich, from 2000: http://www.ncbi.nlm.nih.gov/pubmed/10767497

That all seems reasonable. It's just that your post is the first place I've ever heard of this technique of pushing on a choking person's side. Since it came packaged with snark about the US Heimlich PR I expected to find a lot more information and advocacy for it. Meanwhile the best you can do is provide a link to using normal chest compressions - not applying side compressions as you mentioned.

Isn't applying negative pressure to the lung also a great way to collapse it?

You can survive a single collapsed lung indefinitely. You only have a few minutes to survive not being able to breathe.

Better have a collapsed lung than no life at all.

I've had multiple pneumothoraxes and I was able to breathe (suffering pain.. but I didn't die). You can fix that later with a drain.

If this thing can apply negative pressure to a lung, the airway isn't totally obstructed.

> If this thing can apply negative pressure to a lung, the airway isn't totally obstructed.

Conversely, the instant this thing succeed in dislodging an obstruction, it will apply negative pressure to a lung (or, really, two of them.)

No. The pressure inside the chest cavity, but outside the lungs, has to increase. This can be seen with a buildup of fluid, a sucking chest wound, punctured lung, or herniated diaphragm. With the pressure balance upset, the diaphragm can no longer move far enough to fully inflate the lung.

If you apply vacuum to the airway, you're just going to pull the diaphragm way up into the chest cavity. The lung won't collapse unless the lung tissue itself rips, or the diaphragm gets herniated. This is probably not going to happen, unless you experience explosive decompression or actively try to hold your breath against the suction.

Wow, it seems so obvious now.

That's a hallmark of a great idea.

Simple and smart. I like it and wonder if I should buy one. Seems like cheap insurance.

I wonder, does it work on people with beards? I know this usually causes trouble with sealing masks like this. Even if it doesn't, it's still a really useful device for all the non-bearded people out there, but I have to wonder.

I have a beard, and that's the first thing I thought of. I would guess that it's designed to be pretty forgiving, i.e., no needing a perfect seal.

I'm assuming the company knows the answer to this, I think I'll send them an email.

I'm sure it would be fine with smaller beards, but I'm wondering about big fluffy ones. In any case, let us know what they have to say if they reply!

BRB shaving my face.

I found this on their site https://vimeo.com/user31799477/review/143372612/72fa68229b

Also, it seem all you have to do for a beard is apply a little more pressure to form that seal

This looks like the same type of mask used in bag masks for providing ventilation, in which case a beard can significantly compromise the seal. Our anesthesiologists here recommend shaving your beard for higher risk patients undergoing anesthesia in case they need to be bagged. However beards don't render the mask totally ineffective.

Based on it's shape, it seems the business end of the tube is where the majority of the pressure difference would be created. I suspect that the mask is more to prevent air rushing into the nose/mouth than providing the seal for the suction. With the curved tube extending into the back of the throat, and at the size it seems, I suspect that the soft palate and back of the throat would provide a sufficient seal, with enough pressure applied to the mask and a sharp enough pull on the plunger.

Also, many sailors on industrial boats that I've seen have beards, so I'd suspect that it was a consideration in it's design and probably why the tube is there, instead of just a mask, like the yellow plunger thing.

My mother choked on a piece of steak in a restaurant when I was a child. I didn't know what was going on. She was completely silent.

Someone gave her the Heimlich maneuver and it worked. Good thing to learn.

For $150, it seems very overpriced to me. I expected this to be in the $30 range.

Am I missing some profound piece of engineering that warrants this price? Or is more of a "I think I can charge $X and make s 9x profit" move (which I don't fundamental object to.)

I feel like it might be some of the latter. "You can't really put a price on a human life" and therefore they can overcharge a bit

I'm guessing the FDA approval process isn't exactly cheap, either.

Idk maybe the valve system to dispel air and liquids requires an expensive manufacturing process? There are also lawyer fees to recoup

> Am I missing some profound piece of engineering that warrants this price?

Liability insurance and FDA approval. If you've ever seen the words "For Research Purposes Only" on equipment, that's an indication of profitable device, but small market.

I know people who sell equipment to IVF (in-vitro fertilization) labs that are insane about safety, so their equipment is certainly good enough for general use. However, their volume is sufficiently low that it's just not worth the monetary expenditure given that they have an out simply by labelling things correctly.

Agreed. Developing a medical device is not cheap and unlike most consumer products, these devices need to go through rigorous safety testing to make sure it does what it says it does. A lot of capital is needed just to comply with FDA regulations.

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