Advertisement

Vented Chest Seals for Prevention of Tension Pneumothorax in a Communicating Pneumothorax

      Abstract

      Background

      Tension pneumothorax accounts for 3%–4% of combat casualties and 10% of civilian chest trauma. Air entering a wound via a communicating pneumothorax rather than by the trachea can result in respiratory arrest and death. In such cases, the Committee on Tactical Combat Casualty Care advocates the use of unvented chest seals to prevent respiratory compromise.

      Objective

      A comparison of three commercially available vented chest seals was undertaken to evaluate the efficacy of tension pneumothorax prevention after seal application.

      Methods

      A surgical thoracostomy was created and sealed by placing a shortened 10-mL syringe barrel (with plunger in place) into the wound. Tension pneumothorax was achieved via air introduction through a Cordis to a maximum volume of 50 mL/kg. A 20% drop in mean arterial pressure or a 20% increase in heart rate confirmed hemodynamic compromise. After evacuation, one of three vented chest seals (HyFin®, n = 8; Sentinel®, n = 8, SAM®, n = 8) was applied. Air was injected to a maximum of 50 mL/kg twice, followed by a 10% autologous blood infusion, and finally, a third 50 mL/kg air bolus. Survivors completed all three interventions, and a 15-min recovery period.

      Results

      The introduction of 29.0 (±11.5) mL/kg of air resulted in tension physiology. All three seals effectively evacuated air and blood. Hemodynamic compromise failed to develop with a chest seal in place.

      Conclusions

      HyFin®, SAM®, and Sentinel® vented chest seals are equally effective in evacuating blood and air in a communicating pneumothorax model. All three prevented tension pneumothorax formation after penetrating thoracic trauma.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Belmont Jr., P.J.
        • Goodman G.P.
        • Zacchilli M.
        • Posner M.
        • Evans C.
        • Owens B.D.
        Incidence and epidemiology of combat injuries sustained during “the surge” portion of operation Iraqi Freedom by a US Army brigade combat team.
        J Trauma. 2010; 68: 204-210
        • Shen-Gunther J.
        • Ellison R.
        • Kuhens C.
        • Roach C.J.
        • Jarrard S.
        Operation Enduring Freedom: trends in combat casualty care by forward surgical teams deployed to Afghanistan.
        Mil Med. 2011; 176: 67-78
        • McPherson J.J.
        • Feigin D.S.
        • Bellamy R.F.
        Prevalence of tension pneumothorax in fatally wounded combat casualties.
        J Trauma. 2006; 60: 573-578
        • American College of Surgeons Committee on Trauma
        Thoracic trauma.
        in: ATLS: advanced trauma life support for doctors: student course manual. 8th ed. American College of Surgeons Committee on Trauma, Chicago2008: 87
        • Ayling J.
        An open question.
        Emerg Med Serv. 2004; 33: 44
      1. Committee on Tactical Combat Casualty Care. Preferred features for chest seals. 2010. Available at: http://www.health.mil/Libraries/110808_TCCC_Course_Materials/0501-Preferred-Features-Chest-Seals-110808.pdf. Accessed April 26, 2012.

        • Lee C.
        • Revell M.
        • Porter K.
        • et al.
        The prehospital management of chest injuries: a, consensus statement. Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh.
        Emerg Med J. 2007; 24: 220-224
        • Arnaud F.
        • Tomori T.
        • Teranishi K.
        • Yun J.
        • McCarron R.
        • Mahon R.
        Evaluation of chest seal performance in a swine model: comparison of Asherman vs. Bolin seal.
        Injury. 2008; 39: 1082-1088
        • Committee for the Update of the Guide for the Care and Use of Laboratory Animals
        Guide for the care and use of laboratory animals.
        8th ed. National Academies Press, Washington, DC2010
        • Bellamy R.F.
        History of surgery for penetrating chest trauma.
        Chest Surg Clin N Am. 2000; 10 (viii): 55-70
        • Givens M.L.
        • Ayotte K.
        • Manifold C.
        Needle thoracostomy: implications of computed tomography chest wall thickness.
        Acad Emerg Med. 2004; 11: 211-213
        • Sanchez L.D.
        • Straszewski S.
        • Saghir A.
        • et al.
        Anterior versus lateral needle decompression of tension pneumothorax: comparison by computed tomography chest wall measurement.
        Acad Emerg Med. 2011; 18: 1022-1026
        • Stevens R.L.
        • Rochester A.A.
        • Busko J.
        • et al.
        Needle thoracostomy for tension pneumothorax: failure predicted by chest computed tomography.
        Prehosp Emerg Care. 2009; 13: 14-17
        • Zengerink I.
        • Brink P.R.
        • Laupland K.B.
        • Raber E.L.
        • Zygun D.
        • Kortbeek J.B.
        Needle thoracostomy in the treatment of a tension pneumothorax in trauma patients: what size needle?.
        J Trauma. 2008; 64: 111-114
        • Paul A.O.
        • Kirchhoff C.
        • Kay M.V.
        • et al.
        Malfunction of a Heimlich flutter valve causing tension pneumothorax: case report of a rare complication.
        Patient Saf Surg. 2010; 4: 8
        • Walthall K.
        Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 3: In a penetrating chest wound is a three-sided dressing or a one-way chest seal better at preventing respiratory complications?.
        Emerg Med J. 2012; 29: 342-343
        • Nessen S.C.
        • Cronk D.R.
        • Edens J.
        • Eastridge B.J.
        • Blackbourne L.H.
        US Army split forward surgical team management of mass casualty events in Afghanistan: surgeon performed triage results in excellent outcomes.
        Am J Disaster Med. 2009; 4: 321-329
        • Gutierrez G.
        • Reines H.D.
        • Wulf-Gutierrez M.E.
        Clinical review: hemorrhagic shock.
        Crit Care. 2004; 8: 373-381