Emergency Medical Services Simple Thoracostomy for Traumatic Cardiac Arrest: Postimplementation Experience in a Ground-based Suburban/Rural Emergency Medical Services Agency

Dickson, Robert; Gleisberg, Guy R; Aiken, Michaël; Crocker, K.; Patrick, Casey; Nichols, Tyler; Mason, Christopher; Fioretti, Joseph

doi:10.1016/j.jemermed.2018.05.027

Cited by 18 publications

(17 citation statements)

References 26 publications

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“…This rate was lower compared with that reported in a recent systematic review 3 . Treatment options for EMS personnel in other countries extend to insertion of a chest tube, insertion of an intravenous line, and use of ALS devices 31 . Regarding fluid management, the usefulness of prehospital administration of red blood cells and blood plasma has been reported.…”

Section: Discussionmentioning

confidence: 99%

Association of Prehospital Epinephrine Administration With Survival Among Patients With Traumatic Cardiac Arrest Caused By Traffic Collisions

Aoki

Abe

Oshima

2019

Sci Rep

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For traumatic cardiac arrest (TCA), the effect of prehospital epinephrine administration was unclear. The aim of this study was to evaluate the relationship between prehospital epinephrine administration and survival in patients with TCA caused by traffic collisions. We conducted a nationwide, prospective, population-based observational study involving patients who experienced out-of-hospital cardiac arrest (OHCA) by using the All-Japan Utstein Registry. Blunt trauma patients with TCA who received prehospital epinephrine were compared with those who did not receive prehospital epinephrine. The primary outcome was 1-month survival of patients. The secondary outcome was prehospital return of spontaneous circulation (ROSC). A total of 5,204 patients with TCA were analyzed. Of those, 758 patients (14.6%) received prehospital epinephrine (Epinephrine group), whereas the remaining 4,446 patients (85.4%) did not receive prehospital epinephrine (No epinephrine group). Eleven (1.5%) and 41 (0.9%) patients in the Epinephrine and No epinephrine groups, respectively, survived for 1 month. In addition, 74 (9.8%) and 40 (0.9%) patients achieved prehospital ROSC in the Epinephrine and No epinephrine groups, respectively. In multivariable logistic regression models, prehospital epinephrine administration was not associated with 1-month survival (odds ratio [OR] 1.495, 95% confidence interval [CI] 0.758 to 2.946) and was associated with prehospital ROSC (OR 3.784, 95% CI 2.102 to 6.812). A propensity score-matched analysis showed similar results for 1-month survival (OR 2.363, 95% CI 0.606 to 9,223) and prehospital ROSC (OR 6.870, 95% CI 3.326 to 14.192). Prehospital epinephrine administration in patients with TCA was not associated with 1-month survival, but was beneficial in regard to prehospital ROSC.

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Section: Discussionmentioning

confidence: 99%

Association of Prehospital Epinephrine Administration With Survival Among Patients With Traumatic Cardiac Arrest Caused By Traffic Collisions

Aoki

Abe

Oshima

2019

Sci Rep

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“…A total of 1,420 unique citations were obtained by the literature search strategy, of which 20 original studies (two prospective cohort or case series and 18 retrospective cohort or cases series) fulfilled the inclusion criteria. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] Each study included between 24 and 2,574 patients and most studies (n = 9) were conducted in the United States of America. The main mechanism was blunt trauma.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…The main mechanism was blunt trauma. Twelve studies presented data on efficacy, patient outcomes, and/or adverse events, [19][20][21][22][23][24][25][26][27][28][29]36 while ten studies presented findings limited to anatomical measures and predicted success rate and outcomes (two studies presented results relevant to both categories). 19,[30][31][32][33][34][35][36][37][38] Characteristics of the included studies are presented in Table 1 and Table 2. Robitaille-Fortin, Norman, Archer, et al…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…The most clinically studied chest decompression technique was NCD (n = 7), [19][20][21]23,26,28,29 followed by FT (n = 5) [22][23][24][25]27 and CTP (n = 3). 21,25,26 Overall, the success rate of NCD ranged between 18% and 86%.…”

Section: Efficacy Clinical Outcomes and Adverse Eventsmentioning

confidence: 99%

“…19,28 Using FT, the decompression success rate ranged between 9.7% to 32.0%. [22][23][24][25]27 In a case series of 250 patients following FT or CTP, the reported improvement rate was 30%. 25 One study found an improved oxygen saturation at hospital arrival compared to the on-field oxygen saturation prior to FT (P = .003).…”

Section: Efficacy Clinical Outcomes and Adverse Eventsmentioning

confidence: 99%

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Prehospital Decompression of Pneumothorax: A Systematic Review of Recent Evidence

Robitaille-Fortin

Norman

Archer

et al. 2021

Prehosp. Disaster med.

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Introduction: Pneumothorax remains an important cause of preventable trauma death. The aim of this systematic review is to synthesize the recent evidence on the efficacy, patient outcomes, and adverse events of different chest decompression approaches relevant to the out-of-hospital setting. Methods: A comprehensive literature search was performed using five databases (from January 1, 2014 through June 15, 2020). To be considered eligible, studies required to report original data on decompression of suspected or proven traumatic pneumothorax and be considered relevant to the prehospital context. They also required to be conducted mostly on an adult population (expected more than ≥80% of the population ≥16 years old) of patients. Needle chest decompression (NCD), finger thoracostomy (FT), and tube thoracostomy were considered. No meta-analysis was performed. Level of evidence was assigned using the Harbour and Miller system. Results: A total of 1,420 citations were obtained by the search strategy, of which 20 studies were included. Overall, the level of evidence was low. Eleven studies reported on the efficacy and patient outcomes following chest decompression. The most studied technique was NCD (n = 7), followed by FT (n = 5). Definitions of a successful chest decompression were heterogeneous. Subjective improvement following NCD ranged between 18% and 86% (n = 6). Successful FT was reported for between 9.7% and 32.0% of interventions following a traumatic cardiac arrest. Adverse events were infrequently reported. Nine studies presented only on anatomical measures with predicted failure and success. The mean anterior chest wall thickness (CWT) was larger than the lateral CWT in all studies except one. The predicted success rate of NCD ranged between 90% and 100% when using needle >7cm (n = 7) both for the lateral and anterior approaches. The reported risk of iatrogenic injuries was higher for the lateral approach, mostly on the left side because of the proximity with the heart. Conclusions: Based on observational studies with a low level of evidence, prehospital NCD should be performed using a needle >7cm length with either a lateral or anterior approach. While FT is an interesting diagnostic and therapeutic approach, evidence on the success rates and complications is limited. High-quality studies are required to determine the optimal chest decompression approach applicable in the out-of-hospital setting.

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Daya²

2021

Emergency Medical Services

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Emergency Medical Services Simple Thoracostomy for Traumatic Cardiac Arrest: Postimplementation Experience in a Ground-based Suburban/Rural Emergency Medical Services Agency

Cited by 18 publications

References 26 publications

Association of Prehospital Epinephrine Administration With Survival Among Patients With Traumatic Cardiac Arrest Caused By Traffic Collisions

Association of Prehospital Epinephrine Administration With Survival Among Patients With Traumatic Cardiac Arrest Caused By Traffic Collisions

Prehospital Decompression of Pneumothorax: A Systematic Review of Recent Evidence

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