Ask the Doctor: Dechoker and Tracheostomy

The Dechoker team has received several questions related to the anti-choking device and tracheostomy, which the Mayo Clinic describes as:

“A hole that surgeons make through the front of the neck and into the windpipe (trachea). A tracheostomy tube is placed into the hole to keep it open for breathing. The term for the surgical procedure to create this opening is tracheotomy. A tracheostomy provides an air passage to help you breathe when the usual route for breathing is somehow blocked or reduced.”

Dr. Timothy F. Pingree, M.D., Ear, Nose, and Throat Physician and member of the Dechoker Medical Advisory Team, provided the following responses:

The tracheostomy location is distal from where the Dechoker works, so it will not make sense to use it (the Dechoker).

“I can’t imagine a bolus of food getting stuck distal to (lower in the trachea) the tracheostomy tube, unless it is a small tracheostomy tube or the cuff is deflated (see 3 below)—if it is well-placed, correctly sized and the cuff inflated, a person is safe.”

The location is where Dechoker can act, but the cuff is well inflated and it will stop the food to enter the lungs, so not really an emergency. Should Dechoker be used here?

“This is correct: when correctly functioning with the cuff up, the tracheostomy tube acts as a dam to protect against the lower airway. However, if food or a foreign object were to be aspirated/lodged in the upper airway (below the vocal cords and above tracheostomy tube), the Dechoker could still be used and would likely be helpful, if the patient can’t cough it out spontaneously—in this situation, the patient would likely be anxious but not in an airway emergency. It is Important to deal with things without removing the tracheostomy tube (or deflating it), so the bolus doesn’t move distantly and become an emergency.”

The cuff is not well inflated and food will go down the trachea. Should Dechoker be used here? If yes. Should the tube be removed first? If yes, how will the open stoma affect the suction?

“If a food bolus passes beyond a tracheostomy tube, it is now in a more distal location and is an emergency. In order for the Dechoker to work using normal aerodynamics, the tracheostomy tube should be removed and manual pressure applied to cover the hole (stoma) and create a “normal” airway. An adult hand can easily cover the hole. It woo It may be possible but difficult to  use the Dechoker through the stoma due to the configuration of the device.”

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