Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-25T18:14:11.271Z Has data issue: false hasContentIssue false
  • English
  • Français

Prehospital Decompression of Pneumothorax: A Systematic Review of Recent Evidence

Published online by Cambridge University Press:  25 May 2021

Maxime Robitaille-Fortin Open the ORCID record for Maxime Robitaille-Fortin [Opens in a new window] ,
Sharon Norman Open the ORCID record for Sharon Norman [Opens in a new window] ,
Thomas Archer  and
Eric Mercier Open the ORCID record for Eric Mercier [Opens in a new window]
Maxime Robitaille-Fortin*
Affiliation:
School of Medicine, Cardiff University, Wales, United Kingdom ACCESS Air Ambulance, North West Territory, Yellowknife, Canada Coopérative des Techniciens Ambulanciers du Québec (CTAQ), Québec, Québec, Canada
Sharon Norman
Affiliation:
School of Medicine, Cardiff University, Wales, United Kingdom
Thomas Archer
Affiliation:
School of Medicine, Cardiff University, Wales, United Kingdom Emergency Medical Retrieval and Transfer Service (EMRTS), Wales, United Kingdom
Eric Mercier
Affiliation:
VITAM – Centre de Recherche en Santé Durable de l’Université Laval, Québec, Québec, Canada Centre de recherche du CHU de Québec, Université Laval, Québec, Canada
*
Correspondence: Maxime Robitaille-Fortin, MSc, 6000 rue des Tournelles Québec, QCG2J 1E4Canada, E-mail: maximefortin04@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Pneumothorax remains an important cause of preventable trauma death. The aim of this systematic review is to synthesize the recent evidence on the efficacy, patient outcomes, and adverse events of different chest decompression approaches relevant to the out-of-hospital setting.

Methods:

A comprehensive literature search was performed using five databases (from January 1, 2014 through June 15, 2020). To be considered eligible, studies required to report original data on decompression of suspected or proven traumatic pneumothorax and be considered relevant to the prehospital context. They also required to be conducted mostly on an adult population (expected more than ≥80% of the population ≥16 years old) of patients. Needle chest decompression (NCD), finger thoracostomy (FT), and tube thoracostomy were considered. No meta-analysis was performed. Level of evidence was assigned using the Harbour and Miller system.

Results:

A total of 1,420 citations were obtained by the search strategy, of which 20 studies were included. Overall, the level of evidence was low. Eleven studies reported on the efficacy and patient outcomes following chest decompression. The most studied technique was NCD (n = 7), followed by FT (n = 5). Definitions of a successful chest decompression were heterogeneous. Subjective improvement following NCD ranged between 18% and 86% (n = 6). Successful FT was reported for between 9.7% and 32.0% of interventions following a traumatic cardiac arrest. Adverse events were infrequently reported. Nine studies presented only on anatomical measures with predicted failure and success. The mean anterior chest wall thickness (CWT) was larger than the lateral CWT in all studies except one. The predicted success rate of NCD ranged between 90% and 100% when using needle >7cm (n = 7) both for the lateral and anterior approaches. The reported risk of iatrogenic injuries was higher for the lateral approach, mostly on the left side because of the proximity with the heart.

Conclusions:

Based on observational studies with a low level of evidence, prehospital NCD should be performed using a needle >7cm length with either a lateral or anterior approach. While FT is an interesting diagnostic and therapeutic approach, evidence on the success rates and complications is limited. High-quality studies are required to determine the optimal chest decompression approach applicable in the out-of-hospital setting.

Keywords

decompressionpneumothoraxprehospitalthoracic injuriesthoracostomy
Type
Systematic Review
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 4 , August 2021 , pp. 450 - 459
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bakke, HK, Wisborg, T. Rural high north: a high rate of fatal injury and prehospital death. World J Surgery. 2011;35(7):1615–1620.CrossRefGoogle ScholarPubMed
Beck, B, Smith, K, Mercier, E, et al. Potentially preventable trauma deaths: a retrospective review. Injury. 2019;50(5):1009–1016.CrossRefGoogle ScholarPubMed
Pfeifer, R, Halvachizadeh, S, Schick, S, et al. Are prehospital trauma deaths preventable? A systematic literature review. World J Surgery. 2019;43(10):2438–2446.CrossRefGoogle Scholar
Leigh-Smith, S, Harris, T. Tension pneumothorax--time for a re-think? Emerg Med J. 2005;22(1):8–16.CrossRefGoogle ScholarPubMed
Waydhas, C, Sauerland, S. Pre-hospital pleural decompression and chest tube placement after blunt trauma: a systematic review. Resuscitation. 2007;72(1):11–25.CrossRefGoogle ScholarPubMed
American College of Surgeons Committee on Trauma. Advanced Trauma Life Support-Student Course Manual, 10 th ed. American College of Surgeons: Chicago, Illinois USA; 2018.Google Scholar
Campbell, JE. International Trauma Life Support for Emergency Care Providers. 8th edition. Ontario, Canada: Pearson Education, Inc; 2015.Google Scholar
Wernick, B, Hon, HH, Mubang, RN, et al. Complications of needle thoracostomy: a comprehensive clinical review. Int J Crit Illn Inj Sci. 2015;5(3):160–169.Google ScholarPubMed
Ferrie, EP, Collum, N, McGovern, S. The right place in the right space? Awareness of site for needle thoracocentesis. Emerg Med J. 2005;22(11):788–789.CrossRefGoogle ScholarPubMed
Harcke, HT, Mabry, RL, Mazuchowski, EL. Needle thoracentesis decompression: observations from postmortem computed tomography and autopsy. J Spec Oper Med. 2013;13(4):53–58.Google ScholarPubMed
Leech, C, Porter, K, Steyn, R, et al. The pre-hospital management of life-threatening chest injuries: a consensus statement from the Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh. Trauma. 2016;19(1):54–62.CrossRefGoogle Scholar
Mistry, N, Bleetman, A, Roberts, KJ. Chest decompression during the resuscitation of patients in prehospital traumatic cardiac arrest. Emerg Med J. 2009;26(10):738–740.CrossRefGoogle ScholarPubMed
Massarutti, D, Trillò, G, Berlot, G, et al. Simple thoracostomy in prehospital trauma management is safe and effective: a 2-year experience by helicopter emergency medical crews. Eur J Emerg Med. 2006;13(5):276–280.CrossRefGoogle ScholarPubMed
Clemency, BM, Tanski, CT, Rosenberg, M, May, PR, Consiglio, JD, Lindstrom, HA. Sufficient catheter length for pneumothorax needle decompression: a meta-analysis. Prehosp Disaster Med. 2015;30(3):249–253.CrossRefGoogle ScholarPubMed
Laan, DV, Vu, TD, Thiels, CA, et al. Chest wall thickness and decompression failure: a systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. Injury. 2016;47(4):797–804.CrossRefGoogle ScholarPubMed
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.CrossRefGoogle ScholarPubMed
CASP. CASP Case Control Checklist. https://casp-uk.net/casp-tools-checklists/. Accessed December 2020.Google Scholar
Harbour, R, Miller, J. A new system for grading recommendations in evidence-based guidelines. BMJ. 2001;323(7308):334–336.CrossRefGoogle ScholarPubMed
Aho, JM, Thiels, CA, El Khatib, MM, et al. Needle thoracostomy: clinical effectiveness is improved using a longer Angio catheter. J Trauma Acute Care Surg. 2016;80(2):272–277.CrossRefGoogle Scholar
Axtman, BC, Stewart, KE, Robbins, JM, et al. Prehospital needle thoracostomy: what are the indications and is a post-trauma center arrival chest tube required? Am J Surg. 2019;218(6):1138–1142.CrossRefGoogle ScholarPubMed
Chen, J, Nadler, R, Schwartz, D, Tien, H, Cap, AP, Glassberg, E. Needle thoracostomy for tension pneumothorax: the Israeli Defense Forces experience. Can J Surg. 2015;58(3 Suppl 3):S118–124.CrossRefGoogle ScholarPubMed
Chesters, A, Davies, G, Wilson, A. Four years of pre-hospital simple thoracostomy performed by a physician-paramedic helicopter emergency medical service team: a description and review of practice. Trauma. 2015;18(2):124–128.CrossRefGoogle Scholar
Dickson, RL, Gleisberg, G, Aiken, M, et al. Emergency Medical Services simple thoracostomy for traumatic cardiac arrest: postimplementation experience in a ground-based suburban/rural Emergency Medical Services agency. J Emerg Med. 2018;55(3):366–371.CrossRefGoogle Scholar
Hannon, L, St Clair, T, Smith, K, et al. Finger thoracostomy in patients with chest trauma performed by paramedics on a helicopter emergency medical service. Emerg Med Australas. 2020;32(4):650–656.CrossRefGoogle ScholarPubMed
High, K, Brywczynski, J, Guillamondegui, O. Safety and efficacy of thoracostomy in the air medical environment. Air Med J. 2016;35(4):227–230.CrossRefGoogle ScholarPubMed
Kaserer, A, Stein, P, Simmen, HP, Spahn, DR, Neuhaus, V. Failure rate of prehospital chest decompression after severe thoracic trauma. Am J Emerg Med. 2017;35(3):469–474.CrossRefGoogle ScholarPubMed
Peters, J, Ketelaars, R, van Wageningen, B, Biert, J, Hoogerwerf, N. Prehospital thoracostomy in patients with traumatic circulatory arrest: results from a physician-staffed Helicopter Emergency Medical Service. Eur J Emerg Med. 2017;24(2):96–100.CrossRefGoogle ScholarPubMed
Weichenthal, L, Crane, D, Rond, L. Needle thoracostomy in the prehospital setting: a retrospective observational study. Prehosp Emerg Care. 2016;20(3):399–403.CrossRefGoogle ScholarPubMed
Weichenthal, LA, Owen, S, Stroh, G, Ramos, J. Needle thoracostomy: does changing needle length and location change patient outcome? Prehosp Disaster Med. 2018;33(3):237–244.CrossRefGoogle ScholarPubMed
Blenkinsop, G, Mossadegh, S, Ballard, M, Parker, P. What is the optimal device length and insertion site for needle thoracostomy in UK military casualties? A computed tomography study. J Spec Op Med. 2015;15(3):60–65.Google ScholarPubMed
Chang, SJ, Ross, SW, Kiefer, DJ, et al. Evaluation of 8.0-cm needle at the fourth anterior axillary line for needle chest decompression of tension pneumothorax. J Trauma Acute Care Surg. 2014;76(4):1029–1034.CrossRefGoogle Scholar
Chanthawatthanarak, SKP, Munkong, W, Apiratwarakul, K, Ienghong, K, Bhudhisawasdi, V. Average chest wall thickness at the point of needle decompression in Thai patients. J Med Assoc Thai. 2019;102:888–892.Google Scholar
Goh, S, Xu, WR, Teo, LT. Decompression of tension pneumothoraxes in Asian trauma patients: greater success with lateral approach and longer catheter lengths based on computed tomography chest wall measurements. Eur J Trauma Emerg Surg. 2018;44(5):767–771.CrossRefGoogle Scholar
Hecker, M, Hegenscheid, K, Völzke, H, et al. Needle decompression of tension pneumothorax: population-based epidemiologic approach to adequate needle length in healthy volunteers in Northeast Germany. J Trauma Acute Care Surg. 2016;80(1):119–124.CrossRefGoogle ScholarPubMed
Lamblin, A, Turc, J, Bylicki, O, et al. Measure of chest wall thickness in French soldiers: which technique to use for needle decompression of tension pneumothorax at the front? Military Med. 2014;179(7):783–786.CrossRefGoogle Scholar
Lesperance, RN, Carroll, CM, Aden, JK, Young, JB, Nunez, TC. Failure rate of prehospital needle decompression for tension pneumothorax in trauma patients. Am Surgeon. 2018;84(11):1750–1755.CrossRefGoogle ScholarPubMed
Powers, WF, Clancy, TV, Adams, A, West, TC, Kotwall, CA, Hope, WW. Proper catheter selection for needle thoracostomy: a height and weight-based criteria. Injury. 2014;45(1):107–111.CrossRefGoogle ScholarPubMed
Sirikun, JPB, Wasinrat, J. The accuracy of chest wall thickness: to improve success rate of emergency needle thoracostomy. J Med Assoc Thai. 2017;100(3):115.Google Scholar
Heavyside, A. Sticking the knife in: time to review management of tension pneumothorax. J Paramedic Practice. 2013;5(3):133–138.CrossRefGoogle Scholar
National Institute for Health and Care Excellence. Major trauma: assessment and initial management. https://www.nice.org.uk/guidance/ng39/chapter/Recommendations#management-of-chest-trauma-in-hospital-settings. Accessed December 2020.Google Scholar
Deakin, CD, Davies, G, Wilson, A. Simple thoracostomy avoids chest drain insertion in prehospital trauma. J Trauma. 1995;39(2):373–374.CrossRefGoogle ScholarPubMed
Aylwin, CJ, Brohi, K, Davies, GD, Walsh, MS. Pre-hospital and in-hospital thoracostomy: indications and complications. Ann R Coll Surg Engl. 2008;90(1):54–57.CrossRefGoogle ScholarPubMed
Hew, M, Tay, TR. The efficacy of bedside chest ultrasound: from accuracy to outcomes. Eur Respir Rev. 2016;25(141):230–246.CrossRefGoogle ScholarPubMed
Ketelaars, R, Reijnders, G, van Geffen, GJ, Scheffer, GJ, Hoogerwerf, N. ABCDE of prehospital ultrasonography: a narrative review. Crit Ultrasound J. 2018;10(1):17.CrossRefGoogle ScholarPubMed
Leatherman, ML, Fluke, LM, McEvoy, CS, et al. Bigger is better: comparison of alternative devices for tension hemopneumothorax and pulseless electrical activity in a Yorkshire swine model. J Trauma Acute Care Surg. 2017;83(6):1187–1194.CrossRefGoogle Scholar
Supplementary material: PDF

Robitaille-Fortin et al. supplementary material

Robitaille-Fortin et al. supplementary material

Download Robitaille-Fortin et al. supplementary material(PDF)
PDF 91.7 KB