Prehospital paramedic pleural decompression: A systematic review

Kelsey Sharrock, Brendan Shannon, Carlos Garcia Gonzalez, Toby St Clair, Biswadev Mitra, Michael Noonan, Prof Mark Fitzgerald, Alexander Olaussen

Research output: Contribution to journalReview ArticleResearchpeer-review

11 Citations (Scopus)

Abstract

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: To determine and compare procedural success, complications and mortality between NT and FT for treatment of a suspected TPT when performed by paramedics. Methods: We searched four databases (Ovid Medline, PubMed, CINAHL and Embase) from their commencement until 25th August 2020. Studies were included if they analysed patients suffering from a suspected TPT who were treated in the prehospital setting with a NT or FT by paramedics (or local equivalent nonphysicians). 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: 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.

Original languageEnglish
Pages (from-to)2778-2786
Number of pages9
JournalInjury
Volume52
Issue number10
DOIs
Publication statusPublished - Oct 2021

Keywords

  • Ension pneumothorax
  • Finger thoracostomy
  • Needle thoracostomy
  • Paramedics
  • Pleural decompression
  • Prehospital
  • Tension pneumothorax

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