Prehospital paramedic pleural decompression: A systematic review

Sharrock, Kelsey; Shannon, Brendan; González, Carlos García; Clair, Toby St; Mitra, Biswadev; Noonan, Michael P; Fitzgerald, Mark; Olaussen, Alexander

doi:10.1016/j.injury.2021.08.008

Cited by 11 publications

(14 citation statements)

References 35 publications

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“…Many prior studies report on clinical improvement after PHND and technical success rates of pleural cavity decompression. Clinical improvement rates vary considerably between studies, ranging from 5.7% to 53% after PHND . Several studies reported that improvements in dyspnea and hypoxia were more common than improvement in hemodynamic parameters, although patients with hypotension have a 3-fold higher odds of having improvement in blood pressure than patients without hypotension before PHND .…”

Section: Discussionmentioning

confidence: 51%

“…Clinical improvement rates vary considerably between studies, ranging from 5.7% to 53% after PHND. 7,10,16,18,19 Several studies reported that improvements in dyspnea and hypoxia were more common than improvement in hemodynamic parameters, 7,10,18 although patients with hypotension have a 3-fold higher odds of having improvement in blood pressure than patients without hypotension before PHND. 16 We found comparable rates of physiologic improvement after PHND, with one-third of patients having at least 1 physiologic abnormality improving.…”

Section: Discussionmentioning

confidence: 99%

“…Success of pleural decompression is also highly variable, ranging from 5.9% to 100% with a bimodal distribution of mostly greater than 80% or less than 25% success rates among studies. 19 Complication rates of PHND range from 2% to 13.7%, including iatrogenic pneumothorax or hemothorax, subcutaneous hematoma, and dislodgement or kinking of the catheter, leading to hemodynamic compromise. 7,17 Reported mortality rates after PHND range from 12% to 79% and are universally lower in patients not presenting in traumatic arrest.…”

Section: Discussionmentioning

confidence: 99%

“…7,17 Reported mortality rates after PHND range from 12% to 79% and are universally lower in patients not presenting in traumatic arrest. 9,19 Davis and colleagues 18 found that an improvement in systolic blood pressure after PHND was associated with improved odds of survival, whereas Warner et al 8 found 4 unexpected survivors who obtained return of spontaneous circulation after PHND.…”

Section: Discussionmentioning

confidence: 99%

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Association of Prehospital Needle Decompression With Mortality Among Injured Patients Requiring Emergency Chest Decompression

et al. 2022

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ImportancePrehospital needle decompression (PHND) is a rare but potentially life-saving procedure. Prior studies on chest decompression in trauma patients have been small, limited to single institutions or emergency medical services (EMS) agencies, and lacked appropriate comparator groups, making the effectiveness of this intervention uncertain.ObjectiveTo determine the association of PHND with early mortality in patients requiring emergent chest decompression.Design, Setting, and ParticipantsThis was a retrospective cohort study conducted from January 1, 2000, to March 18, 2020, using the Pennsylvania Trauma Outcomes Study database. Patients older than 15 years who were transported from the scene of injury were included in the analysis. Data were analyzed between April 28, 2021, and September 18, 2021.ExposuresPatients without PHND but undergoing tube thoracostomy within 15 minutes of arrival at the trauma center were the comparison group that may have benefited from PHND.Main Outcomes and MeasuresMixed-effect logistic regression was used to determine the variability in PHND between patient and EMS agency factors, as well as the association between risk-adjusted 24-hour mortality and PHND, accounting for clustering by center and year. Propensity score matching, instrumental variable analysis using EMS agency-level PHND proportion, and several sensitivity analyses were performed to address potential bias.ResultsA total of 8469 patients were included in this study; 1337 patients (11%) had PHND (median [IQR] age, 37 [25-52] years; 1096 male patients [82.0%]), and 7132 patients (84.2%) had emergent tube thoracostomy (median [IQR] age, 32 [23-48] years; 6083 male patients [85.3%]). PHND rates were stable over the study period between 0.2% and 0.5%. Patient factors accounted for 43% of the variation in PHND rates, whereas EMS agency accounted for 57% of the variation. PHND was associated with a 25% decrease in odds of 24-hour mortality (odds ratio [OR], 0.75; 95% CI, 0.61-0.94; P = .01). Similar results were found in patients who survived their ED stay (OR, 0.68; 95% CI, 0.52-0.89; P &lt; .01), excluding severe traumatic brain injury (OR, 0.65; 95% CI, 0.45-0.95; P = .03), and restricted to patients with severe chest injury (OR, 0.72; 95% CI, 0.55-0.93; P = .01). PHND was also associated with lower odds of 24-hour mortality after propensity matching (OR, 0.79; 95% CI, 0.62-0.98; P = .04) when restricting matches to the same EMS agency (OR, 0.74; 95% CI, 0.56-0.99; P = .04) and in instrumental variable probit regression (coefficient, −0.60; 95% CI, –1.04 to –0.16; P &lt; .01).Conclusions and RelevanceIn this cohort study, PHND was associated with lower 24-hour mortality compared with emergent trauma center chest tube placement in trauma patients. Although performed rarely, PHND can be a life-saving intervention and should be reinforced in EMS education for appropriately selected trauma patients.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Association of Prehospital Needle Decompression With Mortality Among Injured Patients Requiring Emergency Chest Decompression

et al. 2022

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“…Few studies report the specific improvements in vital signs that constitute successful decompression. Evidence such as a gush of air on entry, hemodynamic stability, and EMS self-reports are markers of success [ 19 ]. Our study provides objective indicators and endpoints in vital signs to predict a successful decompression based on the criteria for successful decompression, corroborating existing literature regarding using vital signs as indicators and endpoints for needle decompression [ 6 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

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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