Abstract Body: Background: Foreign body airway obstruction (FBAO; choking) can quickly lead to respiratory arrest & death. As FBAOs occur in prehospital settings, survival depends heavily on bystander intervention. Suction-based airway clearance devices (ACDs) are marketed as safer alternatives to traditional maneuvers such as abdominal thrusts. While a previous mannequin study found the LifeVac ACD more effective than AT among healthcare professionals, laypersons are the intended users.

Research Question: Among laypersons, which FBAO intervention—abdominal thrusts (AT), LifeVac ACD (LV), or Dechoker ACD (DC)—is most efficacious at relieving an FBAO within one minute?

Methods: We conducted a simulation-based, open-label, randomized crossover trial in Alberta, Canada. Adult laypersons received standardized in-person instruction on AT, LV, and DC. Each participant responded to three separate simulated FBAO events (one per intervention), with random assignment to one of six intervention order groups. The outcomes were FBAO relief at one minute (primary) and at four minutes (secondary). Attempts were videotaped and outcomes were assessed by two independent hypothesis-blinded adjudicators. A mixed-effects logistic regression model estimated odds ratios (OR) for FBAO relief, adjusted for sequence, carryover, and period effects. Skill retention was evaluated 90–120 days later without retraining, using the same simulation protocol. Target sample size was 132.

Results: Over 7 months, 136 participants were enrolled; 132 were eligible and randomized. Most were female (66%), with a median age of 39 (IQR:26-56). Sixty-eight participants (52%) had current first aid certification, while 40 (30%) had never received first aid training. Adjudicators had perfect outcome agreement (Cohen’s k=1.0). FBAO relief at one minute occurred in 86% (LV), 62% (DC), and 49% (AT) of cases; at four minutes: 97% (LV), 81% (DC), 52% (AT). Compared to AT, LV (OR=12.4; 95%CI: 5.6–27.2) and DC (OR=2.1; 95%CI: 1.2–3.8) had higher odds of one-minute relief. Results were similar at four minutes. In the retention phase, 39 participants returned. At one minute, LV remained superior (OR=97.7; 95%CI: 6.3–1549), while DC did not (OR=1.4; 95%CI: 0.5–4.0); similar findings were observed at four minutes.

Conclusion: After brief training, both ACDs were more efficacious than abdominal thrusts in relieving a simulated FBAO among laypersons. However, at 3–4 months post-training, only LifeVac ACD retained superior efficacy.