Chest wall thickness and decompression failure: A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy

Danuel V. Laan, Trang Diem N Vu, Cornelius A. Thiels, T. K. Pandian, Henry J. Schiller, Mohammad H Murad, Johnathon M. Aho

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Introduction: Current Advanced Trauma Life Support guidelines recommend decompression for thoracic tension physiology using a 5-cm angiocatheter at the second intercostal space (ICS) on the midclavicular line (MCL). High failure rates occur. Through systematic review and meta-analysis, we aimed to determine the chest wall thickness (CWT) of the 2nd ICS-MCL, the 4th/5th ICS at the anterior axillary line (AAL), the 4th/5th ICS mid axillary line (MAL) and needle thoracostomy failure rates using the currently recommended 5-cm angiocatheter. Methods: A comprehensive search of several databases from their inception to July 24, 2014 was conducted. The search was limited to the English language, and all study populations were included. Studies were appraised by two independent reviewers according to a priori defined PRISMA inclusion and exclusion criteria. Continuous outcomes (CWT) were evaluated using weighted mean difference and binary outcomes (failure with 5-cm needle) were assessed using incidence rate. Outcomes were pooled using the random-effects model. Results: The search resulted in 34,652 studies of which 15 were included for CWT analysis, 13 for NT effectiveness. Mean CWT was 42.79. mm (95% CI, 38.78-46.81) at 2nd ICS-MCL, 39.85. mm (95% CI, 28.70-51.00) at MAL, and 34.33. mm (95% CI, 28.20-40.47) at AAL (P = .08). Mean failure rate was 38% (95% CI, 24-54) at 2nd ICS-MCL, 31% (95% CI, 10-64) at MAL, and 13% (95% CI, 8-22) at AAL (P = .01). Conclusion: Evidence from observational studies suggests that the 4th/5th ICS-AAL has the lowest predicted failure rate of needle decompression in multiple populations. Level of evidence: Level 3 SR/MA with up to two negative criteria. Study type: Therapeutic.

Original languageEnglish (US)
JournalInjury
DOIs
StateAccepted/In press - 2015

Fingerprint

Thoracostomy
Thoracic Wall
Decompression
Meta-Analysis
Needles
Advanced Trauma Life Support Care
Population
Observational Studies
Language
Thorax
Databases
Guidelines
Incidence

Keywords

  • Needle decompression
  • Needle decompression location
  • Needle thoracostomy
  • Optimal positioning
  • Tension pneumothorax

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Chest wall thickness and decompression failure : A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. / Laan, Danuel V.; Vu, Trang Diem N; Thiels, Cornelius A.; Pandian, T. K.; Schiller, Henry J.; Murad, Mohammad H; Aho, Johnathon M.

In: Injury, 2015.

Research output: Contribution to journalArticle

Laan, Danuel V. ; Vu, Trang Diem N ; Thiels, Cornelius A. ; Pandian, T. K. ; Schiller, Henry J. ; Murad, Mohammad H ; Aho, Johnathon M. / Chest wall thickness and decompression failure : A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. In: Injury. 2015.
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abstract = "Introduction: Current Advanced Trauma Life Support guidelines recommend decompression for thoracic tension physiology using a 5-cm angiocatheter at the second intercostal space (ICS) on the midclavicular line (MCL). High failure rates occur. Through systematic review and meta-analysis, we aimed to determine the chest wall thickness (CWT) of the 2nd ICS-MCL, the 4th/5th ICS at the anterior axillary line (AAL), the 4th/5th ICS mid axillary line (MAL) and needle thoracostomy failure rates using the currently recommended 5-cm angiocatheter. Methods: A comprehensive search of several databases from their inception to July 24, 2014 was conducted. The search was limited to the English language, and all study populations were included. Studies were appraised by two independent reviewers according to a priori defined PRISMA inclusion and exclusion criteria. Continuous outcomes (CWT) were evaluated using weighted mean difference and binary outcomes (failure with 5-cm needle) were assessed using incidence rate. Outcomes were pooled using the random-effects model. Results: The search resulted in 34,652 studies of which 15 were included for CWT analysis, 13 for NT effectiveness. Mean CWT was 42.79. mm (95{\%} CI, 38.78-46.81) at 2nd ICS-MCL, 39.85. mm (95{\%} CI, 28.70-51.00) at MAL, and 34.33. mm (95{\%} CI, 28.20-40.47) at AAL (P = .08). Mean failure rate was 38{\%} (95{\%} CI, 24-54) at 2nd ICS-MCL, 31{\%} (95{\%} CI, 10-64) at MAL, and 13{\%} (95{\%} CI, 8-22) at AAL (P = .01). Conclusion: Evidence from observational studies suggests that the 4th/5th ICS-AAL has the lowest predicted failure rate of needle decompression in multiple populations. Level of evidence: Level 3 SR/MA with up to two negative criteria. Study type: Therapeutic.",
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T1 - Chest wall thickness and decompression failure

T2 - A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy

AU - Laan, Danuel V.

AU - Vu, Trang Diem N

AU - Thiels, Cornelius A.

AU - Pandian, T. K.

AU - Schiller, Henry J.

AU - Murad, Mohammad H

AU - Aho, Johnathon M.

PY - 2015

Y1 - 2015

N2 - Introduction: Current Advanced Trauma Life Support guidelines recommend decompression for thoracic tension physiology using a 5-cm angiocatheter at the second intercostal space (ICS) on the midclavicular line (MCL). High failure rates occur. Through systematic review and meta-analysis, we aimed to determine the chest wall thickness (CWT) of the 2nd ICS-MCL, the 4th/5th ICS at the anterior axillary line (AAL), the 4th/5th ICS mid axillary line (MAL) and needle thoracostomy failure rates using the currently recommended 5-cm angiocatheter. Methods: A comprehensive search of several databases from their inception to July 24, 2014 was conducted. The search was limited to the English language, and all study populations were included. Studies were appraised by two independent reviewers according to a priori defined PRISMA inclusion and exclusion criteria. Continuous outcomes (CWT) were evaluated using weighted mean difference and binary outcomes (failure with 5-cm needle) were assessed using incidence rate. Outcomes were pooled using the random-effects model. Results: The search resulted in 34,652 studies of which 15 were included for CWT analysis, 13 for NT effectiveness. Mean CWT was 42.79. mm (95% CI, 38.78-46.81) at 2nd ICS-MCL, 39.85. mm (95% CI, 28.70-51.00) at MAL, and 34.33. mm (95% CI, 28.20-40.47) at AAL (P = .08). Mean failure rate was 38% (95% CI, 24-54) at 2nd ICS-MCL, 31% (95% CI, 10-64) at MAL, and 13% (95% CI, 8-22) at AAL (P = .01). Conclusion: Evidence from observational studies suggests that the 4th/5th ICS-AAL has the lowest predicted failure rate of needle decompression in multiple populations. Level of evidence: Level 3 SR/MA with up to two negative criteria. Study type: Therapeutic.

AB - Introduction: Current Advanced Trauma Life Support guidelines recommend decompression for thoracic tension physiology using a 5-cm angiocatheter at the second intercostal space (ICS) on the midclavicular line (MCL). High failure rates occur. Through systematic review and meta-analysis, we aimed to determine the chest wall thickness (CWT) of the 2nd ICS-MCL, the 4th/5th ICS at the anterior axillary line (AAL), the 4th/5th ICS mid axillary line (MAL) and needle thoracostomy failure rates using the currently recommended 5-cm angiocatheter. Methods: A comprehensive search of several databases from their inception to July 24, 2014 was conducted. The search was limited to the English language, and all study populations were included. Studies were appraised by two independent reviewers according to a priori defined PRISMA inclusion and exclusion criteria. Continuous outcomes (CWT) were evaluated using weighted mean difference and binary outcomes (failure with 5-cm needle) were assessed using incidence rate. Outcomes were pooled using the random-effects model. Results: The search resulted in 34,652 studies of which 15 were included for CWT analysis, 13 for NT effectiveness. Mean CWT was 42.79. mm (95% CI, 38.78-46.81) at 2nd ICS-MCL, 39.85. mm (95% CI, 28.70-51.00) at MAL, and 34.33. mm (95% CI, 28.20-40.47) at AAL (P = .08). Mean failure rate was 38% (95% CI, 24-54) at 2nd ICS-MCL, 31% (95% CI, 10-64) at MAL, and 13% (95% CI, 8-22) at AAL (P = .01). Conclusion: Evidence from observational studies suggests that the 4th/5th ICS-AAL has the lowest predicted failure rate of needle decompression in multiple populations. Level of evidence: Level 3 SR/MA with up to two negative criteria. Study type: Therapeutic.

KW - Needle decompression

KW - Needle decompression location

KW - Needle thoracostomy

KW - Optimal positioning

KW - Tension pneumothorax

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