Prehospital paramedic pleural decompression: A systematic review.

Allied Health Personnel Decompression, Surgical Emergency Medical Services Humans Pneumothorax / surgery Prospective Studies Retrospective Studies Thoracostomy
Ension pneumothorax Finger thoracostomy Needle thoracostomy Paramedics Pleural decompression Prehospital Tension pneumothorax

Journal

Injury
ISSN: 1879-0267
Titre abrégé: Injury
Pays: Netherlands
ID NLM: 0226040

Informations de publication

Date de publication:
Oct 2021
Historique:
received: 09 06 2021
revised: 02 08 2021
accepted: 04 08 2021
pubmed: 30 8 2021
medline: 3 11 2021
entrez: 29 8 2021
Statut: ppublish

Résumé

Tension pneumothorax (TPT) is a frequent life-threat following thoracic injury. Time-critical decompression of the pleural cavity improves survival. However, whilst paramedics utilise needle thoracostomy (NT) and/or finger thoracostomy (FT) in the prehospital setting, the superiority of one technique over the other remains unknown. To determine and compare procedural success, complications and mortality between NT and FT for treatment of a suspected TPT when performed by paramedics. We searched four databases (Ovid Medline, PubMed, CINAHL and Embase) from their commencement until 25 The search yielded 293 articles after duplicates were removed of which 19 were included for final analysis. Seventeen studies were retrospective (8 cohort; 7 case series; 2 case control) and two were prospective cohort studies. Only one study was comparative, and none were randomised controlled trials. Most studies were conducted in the USA (n=13) and the remaining in Australia (n=4), Switzerland (n=1) and Canada (n=1). Mortality ranged from 12.5% to 79% for NT and 64.7% to 92.9% for FT patients. A higher proportion of complications were reported among patients managed with NT (13.7%) compared to FT (4.8%). We extracted three common themes from the papers of what constituted as a successful pleural decompression; vital signs improvement, successful pleural cavity access and absence of TPT at hospital arrival. Evidence surrounding prehospital pleural decompression of a TPT by paramedics is limited. Available literature suggests that both FT and NT are safe for pleural decompression, however both procedures have associated complications. Additional high-quality evidence and comparative studies investigating the outcomes of interest is necessary to determine if and which procedure is superior in the prehospital setting.

Sections du résumé

BACKGROUND BACKGROUND
Tension pneumothorax (TPT) is a frequent life-threat following thoracic injury. Time-critical decompression of the pleural cavity improves survival. However, whilst paramedics utilise needle thoracostomy (NT) and/or finger thoracostomy (FT) in the prehospital setting, the superiority of one technique over the other remains unknown.
AIM OBJECTIVE
To determine and compare procedural success, complications and mortality between NT and FT for treatment of a suspected TPT when performed by paramedics.
METHODS METHODS
We searched four databases (Ovid Medline, PubMed, CINAHL and Embase) from their commencement until 25
RESULTS RESULTS
The search yielded 293 articles after duplicates were removed of which 19 were included for final analysis. Seventeen studies were retrospective (8 cohort; 7 case series; 2 case control) and two were prospective cohort studies. Only one study was comparative, and none were randomised controlled trials. Most studies were conducted in the USA (n=13) and the remaining in Australia (n=4), Switzerland (n=1) and Canada (n=1). Mortality ranged from 12.5% to 79% for NT and 64.7% to 92.9% for FT patients. A higher proportion of complications were reported among patients managed with NT (13.7%) compared to FT (4.8%). We extracted three common themes from the papers of what constituted as a successful pleural decompression; vital signs improvement, successful pleural cavity access and absence of TPT at hospital arrival.
CONCLUSION CONCLUSIONS
Evidence surrounding prehospital pleural decompression of a TPT by paramedics is limited. Available literature suggests that both FT and NT are safe for pleural decompression, however both procedures have associated complications. Additional high-quality evidence and comparative studies investigating the outcomes of interest is necessary to determine if and which procedure is superior in the prehospital setting.

Identifiants

DOI: 10.1016/j.injury.2021.08.008 PMID: 34454722
pubmed: 34454722
pii: S0020-1383(21)00686-0
doi: 10.1016/j.injury.2021.08.008
pii:
doi:

Types de publication

Journal Article Review Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

2778-2786

Informations de copyright

Copyright © 2021. Published by Elsevier Ltd.

Déclaration de conflit d'intérêts

Declaration of Competing Interest None declared.

Auteurs

Ms Kelsey Sharrock (MK)

Department of Paramedicine, Monash University, Melbourne, Australia; Ambulance Victoria, Doncaster, Melbourne, Australia.

Brendan Shannon (B)

Department of Paramedicine, Monash University, Melbourne, Australia; Ambulance Victoria, Doncaster, Melbourne, Australia.

Carlos Garcia Gonzalez (C)

Department of Paramedicine, Monash University, Melbourne, Australia.

Toby St Clair (TS)

Department of Paramedicine, Monash University, Melbourne, Australia; Ambulance Victoria, Doncaster, Melbourne, Australia; The Royal Children's Hospital, Department of Trauma, Melbourne, Australia.

Biswadev Mitra (B)

Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University.

Michael Noonan (M)

Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia.

Prof Mark Fitzgerald (PM)

Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia.

Alexander Olaussen (A)

Department of Paramedicine, Monash University, Melbourne, Australia; Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia; Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia. Electronic address: alexander.olaussen@monash.edu.

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Classifications MeSH

questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Personnel de santé › Auxiliaires de santé › Prehospital paramedic pleural decompression: A...
questionsmedicales.fr › Procédures de chirurgie opératoire › Décompression chirurgicale › Prehospital paramedic pleural decompression: A...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Services des urgences médicales › Prehospital paramedic pleural decompression: A...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Prehospital paramedic pleural decompression: A...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Maladies de la plèvre › Pneumothorax › Prehospital paramedic pleural decompression: A...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Prehospital paramedic pleural decompression: A...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Prehospital paramedic pleural decompression: A...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie thoracique › Thoracostomie › Prehospital paramedic pleural decompression: A...