Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-28T12:16:11.935Z Has data issue: false hasContentIssue false
  • English
  • Français

Airway Clearance Using Suction Devices in Prehospital Combat Casualty Care: A Systematic Review

Published online by Cambridge University Press:  10 September 2020

Priya Jain Open the ORCID record for Priya Jain [Opens in a new window] ,
Forhad Akhter ,
Austin Schoppe ,
R. Lyle Hood  and
Robert A. De Lorenzo
Priya Jain
Affiliation:
Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, Texas, USA Department of Biomedical Engineering, The University of Texas at San Antonio, San Antonio, Texas, USA Graduate School of Biomedical Sciences, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
Forhad Akhter
Affiliation:
Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, Texas, USA
Austin Schoppe
Affiliation:
Department of Biomedical Engineering, The University of Texas at San Antonio, San Antonio, Texas, USA
R. Lyle Hood
Affiliation:
Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, Texas, USA Graduate School of Biomedical Sciences, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA Department of Emergency Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
Robert A. De Lorenzo*
Affiliation:
Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, Texas, USA Graduate School of Biomedical Sciences, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA Department of Emergency Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
*
Correspondence: Robert A. De Lorenzo, MD, MSM, MSCI, FACEP, Department of Emergency Medicine, UT Health San Antonio (UTHSA), 7703 Floyd Curl Drive, Mail Code 7736, San Antonio, Texas78229-3900USA, E-mail: DeLorenzo@uthscsa.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Airway management is at the forefront for combat medics dealing with battlefield trauma. For military service members, compromised airways are the second leading cause of potentially survivable death on the battlefield, accounting for one in ten preventable combat deaths. Effective suction is a critical component of airway clearance. However, currently available devices are too heavy and bulky to be carried by combat medics and are insufficiently powered. The industry has not responded to the need, with companies continuing to produce models using 1970s technology. A literature review was completed with the assistance of a librarian. The databases searched included: Biomedical Research Database (BRD), Computer Retrieval of Information of Scientific Projects (CRISP), Federal Research in Progress (FEDRIP), Defense Technical Information Center (DTIC), Pub Med/Medline, and OVID. Additionally, a Google Scholar search was performed to identify nonstandard sources. After screening, a total of 40 articles were used. There were no randomized controlled trials or other high-quality evidence that addressed the issues; there was limited peer-reviewed literature on the use, effectiveness, adverse effects, and safety of suction for use in combat casualty care. A review of the available literature revealed no standards, either proposed, validated, or accepted, for the safety or avoidance of adverse effects for portable suction device use in combat casualty care. Similarly, there are no accepted standards to guide the safe use and anticipated adverse effects of suction for use in prehospital combat or emergency care. Nevertheless, there are meaningful data that can be extracted from the few studies available combined with non-clinical studies, narrative reviews and case reports, and expert opinions.

Keywords

airway managementairway suction devicecombat medicoropharyngeal airway clearancesprehospital combat casualty care
Type
Systematic Review
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 6 , December 2020 , pp. 676 - 682
Check for updates
Copyright
© The Author(s), 2020. 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

Costello, MF. Design, Fabrication, and Testing of a Portable Suction Pump. Corvallis, Oregon USA: Oregon State University; 2000.10.21236/ADA375291CrossRefGoogle Scholar
Matten, EC, Shear, T, Vender, JS. Non-intubation management of the airway: airway maneuvers and mask ventilation. Benumof and Hagberg’s Airway Management. 2013;15:324–339.10.1016/B978-1-4377-2764-7.00015-4CrossRefGoogle Scholar
Mabry, RL, Edens, JW, Pearse, L, Kelly, JF, Harke, H. Fatal airway injuries during Operation Enduring Freedom and Operation Iraqi Freedom. Prehosp Emerg Care. 2010;14(2):272–277.10.3109/10903120903537205CrossRefGoogle ScholarPubMed
Kotwal, RS, Montgomery, HR, Kotwal, BM, et al. Eliminating preventable death on the battlefield. Arch Surg-Chicago. 2011;146(12):1350–1358.10.1001/archsurg.2011.213CrossRefGoogle ScholarPubMed
Mabry, RL, Frankfurt, A. Advanced airway management in combat casualties by medics at the point of injury: a sub-group analysis of the reach study. J Spec Oper Med. 2011;11(2):16–19.Google ScholarPubMed
Eastridge, BJ, Mabry, RL, Seguin, P, et al. Death on the battlefield (2001-2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S431–S437.Google ScholarPubMed
Gerhardt, RT, Mabry, R, De Lorenzo, RA, Butler, F. “Fundamentals of combat casualty care.” In: Combat Casualty Care: Lessons Learned from OEF and OIF. Washington, DC USA: United States Department of Defense; 2012:85–120.Google Scholar
Shannon, A, Goldsmith, A. Suction devices. Anaesth Intens Care. 2009;10(10):468–470.Google Scholar
Henlin, T, Sotak, M, Kovaricek, P, Tyll, T, Balcarek, L, Michalek, P. Comparison of five 2nd-generation supraglottic airway devices for airway management performed by novice military operators. Biomed Res-International. 2015.10.1155/2015/201898CrossRefGoogle ScholarPubMed
Uhaa, NA, Naylor, JF, De Lorenzo, RA, Schauer, SG. Editor Ounces Make Pounds, Pounds Make Pain – An Assessment of The Medic Aid Bag. Poster presented at: Military Health System Research Symposium (MHSRS); August 19-22, 2019; Orlando, Florida USA.Google Scholar
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG; The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009;6(7):e1000097.10.1371/journal.pmed.1000097CrossRefGoogle ScholarPubMed
Vandenberg, JT, Vinson, DR. The inadequacies of contemporary oropharyngeal suction. Am J of Emerg Med. 1999;17(6):611–613.10.1016/S0735-6757(99)90210-3CrossRefGoogle ScholarPubMed
De Lorenzo, RA. A Report on Deliverable One: Determine Required Performance Characteristics [of Suction] for Management of Prehospital Combat Casualty Care Injuries. Fort Belvoir, Virginia USA: Defense Technical Information Center (DTIC); 2017.Google Scholar
De Lorenzo, RA, Porter, RS. Tactical Emergency Care: Military and Operational Out-of-Hospital Medicine. Upper Saddle River, New Jersey: Brady (Prentice Hall); 1999.Google Scholar
Perry, AG, Potter, PA, Ostendorf, W. Clinical Nursing Skills and Techniques. Amsterdam, The Netherlands: Elsevier Health Sciences; 2013.Google Scholar
Czarnik, R, Stone, K, Everhart, JC, Preusser, B. Differential effects of continuous versus intermittent suction on tracheal tissue. Heart Lung. 1991;20(2):144–151.Google ScholarPubMed
Ashurst, S. Suction therapy in the critically ill patient. Brit J Nur. 1992;1(10):485–489.10.12968/bjon.1992.1.10.485CrossRefGoogle ScholarPubMed
Arroyo-Novoa, CM, Figueroa-Ramos, MI, Puntillo, KA, et al. Pain related to tracheal suctioning in awake acutely and critically ill adults: a descriptive study. Intens Crit Care Nur. 2008;24(1):20–27.10.1016/j.iccn.2007.05.002CrossRefGoogle ScholarPubMed
Carroll, P. Improve your suctioning technique. RN. 2003;66(5):30ac2.Google ScholarPubMed
Butler, FK Jr, Bagian, J. Tactical combat casualty care 2007: evolving concepts and battlefield experience. Mil Med. 2007;172(11):1.Google ScholarPubMed
Hodgetts, T, Mahoney, P, Evans, G, Russell, R. Battlefield advanced trauma life support. JR Army Med Corps. 2006;152:1–3.Google Scholar
Vandenberg, JT, Lutz, RH, Vinson, DR. Large-diameter suction system reduces oropharyngeal evacuation time. J Emerg Med. 1999;17(6):941–944.Google ScholarPubMed
DePaso, WJ. Aspiration pneumonia. Clin Chest Med. 1991;12(2):269–284.Google ScholarPubMed
Calkins, MMD, Robinson, LTD. Combat trauma airway management: endotracheal intubation versus laryngeal mask airway versus combitube use by Navy SEAL and reconnaissance combat corpsmen. J Trauma Acute Care Surg. 1999;46(5):927–932.10.1097/00005373-199905000-00025CrossRefGoogle ScholarPubMed
Adams, BD, Cuniowski, PA, Muck, A, De Lorenzo, RA. Registry of emergency airways arriving at combat hospitals. J Trauma Acute Care Surg. 2008;64(6):1548–1554.10.1097/TA.0b013e3181728c41CrossRefGoogle ScholarPubMed
Keller, MW, Han, PP, Galarneau, MR, Brigger, MT. Airway management in severe combat maxillofacial trauma. Otolaryng Head Neck. 2015;153(4):532–537.10.1177/0194599815576916CrossRefGoogle ScholarPubMed
Sebesta, J. Special lessons learned from Iraq. Surg Clin. 2006;86(3):711–726.Google ScholarPubMed
Beekley, AC, Bohman, H, Schindler, D. “Modern warfare.” In: Combat Casualty Care: Lessons Learned from OEF and OIF. Washington, DC USA: United States Department of Defense; 2012:4–37.Google Scholar
Kozak, RJ, Ginther, BE, Bean, WS. Difficulties with portable suction equipment used for prehospital advanced airway procedures. Prehosp Emerg Care. 1997;1(2):91–95.10.1080/10903129708958795CrossRefGoogle ScholarPubMed
Kashani, KB, Farmer, JC. The support of severe respiratory failure beyond the hospital and during transportation. Curr Opin Critical Care. 2006;12(1):43–49.10.1097/01.ccx.0000198057.35212.3eCrossRefGoogle ScholarPubMed
Rossi, R, Jäger, G, Ahnefeld, F, Pfenninger, E. Efficiency of suction pumps for the emergency medicine setting. Arch Emerg Med. 1992;9(1):44.10.1136/emj.9.1.44CrossRefGoogle ScholarPubMed
Kinzle, R. Development of a Field Packable Medical Suction Device. [Report]. 2011.Google Scholar
US Army. Tactical Combat Casualty Care: Lessons and Best Practices. Ft. Leavenworth, Kansas USA: US Army; 2012.Google Scholar
Cloonan, CC. “Don’t just do something, stand there!” To teach or not to teach, that is the question--intravenous fluid resuscitation training for Combat Lifesavers. J Trauma. 2003;54(5 Suppl):S20–S25.Google ScholarPubMed
Dahlgren, B-E, Hogberg, R, Nilsson, HG. Portable, but suitable: devices in prehospital care might be hazardous to patient or to aviation safety. Prehosp Disaster Med. 1997;12(1):64–67.Google ScholarPubMed
Committee on Tactical Combat Casualty Care (TCCC). Tactical Combat Casualty Care Guidelines for Medical Personnel. TCCC; 2017.Google Scholar
De Lorenzo, RA, Hood, RL, Jain, P, Pescador, R, Lasch, M, Feng, Y. Summary of Findings and Recommendations for Suction Devices for Management of Prehospital Combat Casualty Care Injuries. Fort Belvoir, Virginia USA: Defense Technical Information Center (DTIC); 2017.Google Scholar
Jain, P, Hood, RL, De Lorenzo, RA. A Report on Deliverable Five: Evaluate Current Commercially Available Suction Pump Devices for Use in Prehospital Combat Care. Fort Belvoir, Virginia USA: Defense Technical Information Center (DTIC); 2017.Google Scholar
Akhter, F, Schoppe, A, Navarro, O, et al. Characterization of a novel emergency suction device for combat medics. J Med Dev. 2019;13(4).Google Scholar
Overend, TJ, Anderson, CM, Brooks, D, et al. Updating the evidence base for suctioning adult patients: a systematic review. Can Respir J. 2009;16(3):e6–e17.10.1155/2009/872921CrossRefGoogle ScholarPubMed