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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Open Access 01-12-2021 | Thoracic Trauma | Review

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

Authors: Stian Mohrsen, Niall McMahon, Alasdair Corfield, Sinéad McKee

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2021

Abstract

Background

Open 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 findings

A 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.

Conclusion

There 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.

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Title: Complications associated with pre-hospital open thoracostomies: a rapid review
Authors: Stian Mohrsen
Niall McMahon
Alasdair Corfield
Sinéad McKee
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Thoracic Trauma
Pneumothorax
Pneumothorax
Pneumothorax
Care
Thoracic Trauma
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2021
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/s13049-021-00976-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Main findings

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Main findings

Conclusion

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