Needle Thoracostomy for Patients with Prolonged Transport Times: A Case-control Study

Weichenthal, Lori; Crane, Desiree; Rond, Luke; Roche, Conal

doi:10.1017/s1049023x15004902

Cited by 6 publications

(5 citation statements)

References 11 publications

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“…Twelve studies32–43 addressed respiratory management (n=2006), specifically needle decompression33 37–43 and tube thoracostomy 32 35 36 43. One study explored mechanical ventilation during patient transfer from a combat hospital to a medical center in Germany, assessing compliance of appropriate ventilator settings according to the ARDSNet (Acute Respiratory Distress Syndrome Network) guidelines.…”

Section: Resultsmentioning

confidence: 99%

“…Three RCTs46 61 63 had low risk of bias (tables 2–4, and online supplemental table 3). Forty-three (78%) of non-randomized cohort studies were classified as having poor evidence quality8 10–15 18–33 35 38 40–43 45 49 51 52 54 55 57–59 69 70 and 12 (22%)16 17 36 37 44 47 50 53 56 60 65 66 had good evidence quality as per the NOS. In addition, the diagnostic studies68–70 included in this review had a high overall risk of bias as per QUADAS-2.…”

Section: Resultsmentioning

confidence: 99%

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Evaluating the Tactical Combat Casualty Care principles in civilian and military settings: systematic review, knowledge gap analysis and recommendations for future research

Strauss

Menchetti

Perrier

et al. 2021

Trauma Surg Acute Care Open

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ObjectivesThe Tactical Combat Casualty Care (TCCC) guidelines detail resuscitation practices in prehospital and austere environments. We sought to review the content and quality of the current TCCC and civilian prehospital literature and characterize knowledge gaps to offer recommendations for future research.MethodsMEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials were searched for studies assessing intervention techniques and devices used in civilian and military prehospital settings that could be applied to TCCC guidelines. Screening and data extraction were performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quality appraisal was conducted using appropriate tools.ResultsNinety-two percent (n=57) of studies were observational. Most randomized trials had low risk of bias, whereas observational studies had higher risk of bias. Interventions of massive hemorrhage control (n=17) were wound dressings and tourniquets, suggesting effective hemodynamic control. Airway management interventions (n=7) had high success rates with improved outcomes. Interventions of respiratory management (n=12) reported low success with needle decompression. Studies assessing circulation (n=18) had higher quality of evidence and suggested improved outcomes with component hemostatic therapy. Hypothermia prevention interventions (n=2) were generally effective. Other studies identified assessed the use of extended focused assessment with sonography in trauma (n=3) and mixed interventions (n=2).ConclusionsThe evidence was largely non-randomized with heterogeneous populations, interventions, and outcomes, precluding robust conclusions in most subjects addressed in the review. Knowledge gaps identified included the use of blood products and concentrate of clotting factors in the prehospital setting.Level of evidenceSystematic review, level III.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Evaluating the Tactical Combat Casualty Care principles in civilian and military settings: systematic review, knowledge gap analysis and recommendations for future research

Strauss

Menchetti

Perrier

et al. 2021

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

show abstract

“…This can occur in blunt trauma through fractured ribs lacerating the visceral pleura or through a breach in the chest wall with penetrating trauma. Pressure build-up in one hemithorax pushes the mediastinal contents to the contralateral side, causing tension pneumothorax which can develop with visceral pleura disruption or tracheobronchial tree injury [ 1 , 2 , 5 , 7 , 10 - 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Needle decompression is a technique taught to emergency medical providers to treat patients with suspected tension pneumothorax [ 2 ]. According to ATLS guidelines, diagnosis of tension pneumothorax requires acute respiratory distress, absent unilateral breath sounds, and tracheal shift [ 5 - 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…The American College of Surgeons Advanced Trauma Life Support (ATLS) and Prehospital Trauma Life Support (PHTLS) recommend needle decompression as the initial treatment for tension pneumothorax [ 5 , 6 ]. However, neither gives specific quantitative guidelines for performing these procedures or the endpoints to indicate success [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Endpoints in Vital Signs as a Useful Tool for Measuring Successful Needle Decompression After Traumatic Tension Pneumothorax: An Analysis of the National Emergency Medicine Information System Database

Okeke¹,

Hoag²,

Culhane³

2022

Cureus

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BackgroundNeedle decompression is a useful tool in the pre-hospital setting for treating tension pneumothorax. However the specific improvements in vital signs that determine a successful decompression are only reported in a few studies and Emergency Medical Services (EMS) self-reported assessments of improvement are more commonplace. We hypothesize that EMS reports may exaggerate improvement when compared to objective vital sign changes. MethodologyThis is a retrospective cohort study using the National Emergency Medicine Information System (NEMSIS) for the year 2020. Vital signs recorded as objective endpoints include systolic blood pressure (SBP), pulse (HR), respiratory rate (RR), and oxygen saturation (SpO 2 ). Univariate analysis was performed using the t-test for continuous variables and the chi-square test for categorical variables. ResultsA total of 8,219 calls were included in the sample size analyzed. Most patients were white (2,911, 35.4%) and male (6,694, 81.4%). Abnormal vitals recorded as indications for needle decompression included SBP <100 mmHg, HR <60 or >100 beats/minute, RR <12 or >20 breaths/minute, and SpO 2 <93%. Statistically significant improvements were seen in the number of abnormal vital signs after the procedure. The percentage of improvement was higher in the EMS self-reported assessment than in objective findings for oxygen saturation and SBP. ConclusionsOur analysis shows objective improvement of hypoxia and hypotension after field needle decompression, supporting the efficacy of the procedure. The improvement based on vital sign change is modest and is less than that reported by EMS assessment of global improvement. This represents a target for quality improvement in EMS practice.

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Prehospital paramedic pleural decompression: A systematic review

Sharrock

Shannon

González

et al. 2021

Injury

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Needle Thoracostomy for Patients with Prolonged Transport Times: A Case-control Study

Cited by 6 publications

References 11 publications

Evaluating the Tactical Combat Casualty Care principles in civilian and military settings: systematic review, knowledge gap analysis and recommendations for future research

Evaluating the Tactical Combat Casualty Care principles in civilian and military settings: systematic review, knowledge gap analysis and recommendations for future research

Endpoints in Vital Signs as a Useful Tool for Measuring Successful Needle Decompression After Traumatic Tension Pneumothorax: An Analysis of the National Emergency Medicine Information System Database

Prehospital paramedic pleural decompression: A systematic review

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