2025年 成人呼吸道異物哽塞改版 AHA ACLS BLS updates

2026-01-13 09:00AM

呼吸道異物哽塞若發生意識不清則作CPR. 跟舊版相同.

意識清醒成人. 新版的建議可先拍背五次, 跟嬰兒的處理相同

理由:

1. 拍背能解除呼吸道異物梗塞

2. 曾有個案因腹部衝擊造成胃破裂

AHA-Part 7: 

Adult Basic Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

成人FBAO 緩解清醒成年患者的異物阻塞性氣道疾病

概要

異物阻塞氣道（FBAO）是常見的醫療急症，也是美國意外死亡的主要原因之一，2021年病例超過5,000例。 大多數成人FBAO病例由食物引起，而兒童FBAO通常由食物和非食物物質引起。 FBAO病例通常依阻塞程度分為輕度或重度。輕度或部分性氣道阻塞通常表現為咳嗽和呼吸困難。這些病例通常可透過咳嗽自行緩解，但也可能進展為完全性氣道阻塞。重度或完全性氣道阻塞表現為咳嗽無力或消失、無法說話、面色改變（紫紺）和意識水平改變，如果異物未被取出，則可能迅速進展為昏迷、呼吸暫停和心臟驟停。氣道阻塞時間越長，發病率和死亡率越高。2. 非專業施救者及時採取適當措施緩解異物阻塞與更高的生存率和良好的神經系統預後相關。 3 . 此外，無論異物是否取出，啟動急救服務都至關重要，以便提供更多異物阻塞移除技術，並將患者送往醫院接受進一步治療。

推薦支援文本

1.

目前尚無隨機對照試驗比較不同幹預措施治療異物阻塞性氣道阻塞（FBAO）的療效和安全性，且關於在醫療和非醫療機構中FBAO最有效幹預順序的證據也十分有限。一項 納入709位FBAO患者的隊列研究顯示，與腹部衝擊相比，背部拍擊可提高FBAO緩解率並減少損傷。此外，病例報告描述了腹部衝擊導致的致命性損傷，包括主動脈剝離和胃破裂。建議交替進行 5次背部拍擊和5次腹部衝擊，是基於與現有採用此方法的嬰幼兒指南保持一致的考量。

2.

先前觀察性研究表明，FBAO患者通常需要多次幹預才能成功取出異物。嚴重的FBAO病例往往需要院前急救人員介入或送至醫院進行評估和治療。因此，對於嚴重的FBAO ， 及時啟動緊急醫療回應系統至關重要。

3.

咳嗽可產生較高的氣道壓力，因此能有效清除部分阻塞。輕度異物阻塞可迅速進展；因此，監測嚴重阻塞的跡象至關重要。

Adult FBAO

Relief of FBAO in Conscious Adult Patients

Synopsis

FBAO is a common medical emergency and one of the leading causes of accidental death in the United States, with over 5000 cases in 2021.1 Most adult FBAO cases are due to food, while FBAOs in pediatrics are commonly caused by both food and nonfood material. Cases of FBAO are often classified as mild or severe depending on the degree of obstruction. Mild, or partial, airway obstructions often present with coughing and difficulty breathing. These cases can often be relieved spontaneously with coughing, however, can progress to complete airway obstructions. Severe, or complete, airway obstructions present with weak or absent coughing, inability to speak, changes in color (cyanosis), and altered level of consciousness, which can rapidly progress to unconsciousness, apnea, and cardiac arrest if the foreign body is not removed. Longer airway obstruction time is associated with high morbidity and mortality.2 Prompt performance of appropriate interventions to relieve the FBAO by lay rescuers has been associated with improved survival and favorable neurological outcome.3 Additionally, activation of emergency medical services is important to provide additional techniques for FBAO removal and provide transport to a hospital for further care, regardless of removal of the foreign body.

Recommendation-Specific Supportive Text

1.

There are no RCTs comparing the efficacy or safety of different interventions for FBAO, and limited evidence about the most effective sequence of FBAO interventions in both health care and non–health care settings.3,4 A cohort study5 of 709 persons with FBAO showed back blows were associated with improved rates of FBAO relief and fewer injuries compared to abdominal thrusts. In addition, case reports have described fatal injuries from abdominal thrusts including aortic dissection and gastric rupture.4,6,7 The recommendation for alternating sets of 5 back blows and 5 abdominal thrusts is based on the value of consistency with existing infant and pediatric guidelines that use this approach.8,9

2.

Previous observational studies have demonstrated that patients with FBAO commonly require multiple interventions before the foreign body is successfully removed. Severe FBAO cases often require intervention by prehospital care personnel or evaluation and treatment at a hospital.3,5 Thus, promptly activating the emergency medical response system is essential for severe FBAO.

3.

Coughing can produce high airway pressures,10,11 making it effective in clearing partial obstructions. Mild FBAO can quickly progress; therefore, monitoring for signs of severe obstruction is crucial.