TY - JOUR
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, M. Hassan
AU - Aho, Johnathon M.
N1 - Publisher Copyright:
© 2016 Elsevier Ltd.
PY - 2016/4/1
Y1 - 2016/4/1
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
UR - http://www.scopus.com/inward/record.url?scp=84951774393&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84951774393&partnerID=8YFLogxK
U2 - 10.1016/j.injury.2015.11.045
DO - 10.1016/j.injury.2015.11.045
M3 - Article
C2 - 26724173
AN - SCOPUS:84951774393
SN - 0020-1383
VL - 47
SP - 797
EP - 804
JO - Injury
JF - Injury
IS - 4
ER -