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Sharrock MK, Shannon B, Garcia Gonzalez C, Clair TS, Mitra B, Noonan M, Fitzgerald PM, Olaussen A. Prehospital paramedic pleural decompression: A systematic review. Injury 2021; 52:2778-2786. [PMID: 34454722 DOI: 10.1016/j.injury.2021.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 02/02/2023]
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.
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Affiliation(s)
- Ms Kelsey Sharrock
- Department of Paramedicine, Monash University, Melbourne, Australia; Ambulance Victoria, Doncaster, Melbourne, Australia
| | - Brendan Shannon
- Department of Paramedicine, Monash University, Melbourne, Australia; Ambulance Victoria, Doncaster, Melbourne, Australia
| | | | - Toby St Clair
- Department of Paramedicine, Monash University, Melbourne, Australia; Ambulance Victoria, Doncaster, Melbourne, Australia; The Royal Children's Hospital, Department of Trauma, Melbourne, Australia
| | - Biswadev Mitra
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University
| | - Michael Noonan
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia
| | - Prof Mark Fitzgerald
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| | - Alexander Olaussen
- 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.
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Reid C, Healy G, Burns B, Habig K. Potential complication of the cruciform trauma position. Emerg Med Australas 2017; 29:477-478. [DOI: 10.1111/1742-6723.12786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 03/28/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Cliff Reid
- Great Sydney Area HEMS; Ambulance Service of New South Wales; Sydney New South Wales Australia
| | - Geoff Healy
- Great Sydney Area HEMS; Ambulance Service of New South Wales; Sydney New South Wales Australia
| | - Brian Burns
- Great Sydney Area HEMS; Ambulance Service of New South Wales; Sydney New South Wales Australia
| | - Karel Habig
- Great Sydney Area HEMS; Ambulance Service of New South Wales; Sydney New South Wales Australia
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