Prehospital paramedic pleural decompression: A systematic review

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

doi:10.1016/j.injury.2021.08.008

Prehospital paramedic pleural decompression: A systematic review

Injury. 2021 Oct;52(10):2778-2786. doi: 10.1016/j.injury.2021.08.008. Epub 2021 Aug 11.

Authors

Ms Kelsey Sharrock¹, Brendan Shannon¹, Carlos Garcia Gonzalez², Toby St Clair³, Biswadev Mitra⁴, Michael Noonan⁵, Prof Mark Fitzgerald⁶, Alexander Olaussen⁷

Affiliations

¹ Department of Paramedicine, Monash University, Melbourne, Australia; Ambulance Victoria, Doncaster, Melbourne, Australia.
² Department of Paramedicine, Monash University, Melbourne, Australia.
³ Department of Paramedicine, Monash University, Melbourne, Australia; Ambulance Victoria, Doncaster, Melbourne, Australia; The Royal Children's Hospital, Department of Trauma, Melbourne, Australia.
⁴ Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University.
⁵ Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia.
⁶ Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia.
⁷ 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.

PMID: 34454722
DOI: 10.1016/j.injury.2021.08.008

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 25^th 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.

Keywords: Ension pneumothorax; Finger thoracostomy; Needle thoracostomy; Paramedics; Pleural decompression; Prehospital; Tension pneumothorax.

Publication types

Review
Systematic Review

MeSH terms

Allied Health Personnel
Decompression, Surgical
Emergency Medical Services*
Humans
Pneumothorax* / surgery
Prospective Studies
Retrospective Studies
Thoracostomy