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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
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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
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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