Complications associated with pre-hospital open thoracostomies: a rapid review

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Sinéad McKee¹  Alasdair Corfield²  Niall McMahon²  Stian Mohrsen³ 

[1] Department of Nursing, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, G4 0BA, Glasgow, Scotland, UK;ScotSTAR, Emergency Medical Retrieval Service, 180 Abbotsinch Road, PA2 3RY, Paisley, UK;ScotSTAR, Emergency Medical Retrieval Service, 180 Abbotsinch Road, PA2 3RY, Paisley, UK;Faculty of Health Sciences and Sport, University of Stirling, FK9 4LA, Stirling, Scotland, UK;

关键词: Emergency medical services;    Critical care;    Thoracic injuries;    Pneumothorax;    Thoracostomy;    Intraoperative complications;   

DOI  :  10.1186/s13049-021-00976-1

来源: Springer

【 摘 要 】

BackgroundOpen thoracostomies have become the standard of care in pre-hospital critical care in patients with chest injuries receiving positive pressure ventilation. The procedure has embedded itself as a rapid method to decompress air or fluid in the chest cavity since its original description in 1995, with a complication rate equal to or better than the out-of-hospital insertion of indwelling pleural catheters. A literature review was performed to explore potential negative implications of open thoracostomies and discuss its role in mechanically ventilated patients without clinical features of pneumothorax.Main findingsA rapid review of key healthcare databases showed a significant rate of complications associated with pre-hospital open thoracostomies. Of 352 thoracostomies included in the final analysis, 10.6% (n = 38) led to complications of which most were related to operator error or infection (n = 26). Pneumothoraces were missed in 2.2% (n = 8) of all cases.ConclusionThere is an appreciable complication rate associated with pre-hospital open thoracostomy. Based on a risk/benefit decision for individual patients, it may be appropriate to withhold intervention in the absence of clinical features, but consideration must be given to the environment where the patient will be monitored during care and transfer. Chest ultrasound can be an effective assessment adjunct to rule in pneumothorax, and may have a role in mitigating the rate of missed cases.

【 授权许可】

CC BY