Chest Tube (CCT)
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Supportive (Green)
|
Survival
|
Patient
|
PH-Paramedic
|
Huber-Wagner S., et al. Outcome of 757 severely injured patients with traumatic cardiorespiratory arrest. Resus 2007; 75:276-85. Medline
|
II
|
Supportive (Green)
|
Efficacy & safety
|
Patient
|
Other
|
Kushida Y, Takeuchi I, Muramatsu KI, Nagasawa H, Jitsuiki K, et al. A Comparison of Tube Thoracostomy for Chest Trauma Between Prehospital and Inhospital Settings. Air Med J 2023; 42(1):24-7. Medline
|
II
|
Neutral (Yellow)
|
Improvement in clinical status
|
Patient
|
|
Barton ED., Epperson M., Hoyt DB., et al. Prehospital needle aspiration and tube thoracostomy in trauma victims: A six-year experience with aeromedical crews. J Emerg Med 1995; 13(2):155-63. Medline
|
II
|
Neutral (Yellow)
|
Multi-organ failure rate
|
Patient
|
PH-Paramedic
|
Regel G., Stalp M., Lehmann U., Seekamp A. Prehospital care, importance of early intervention on outcome. Acta Anaesthesiol Scand Suppl 1997; 110:71-6. Medline
|
III
|
Supportive (Green)
|
Improved vital signs
|
Process
|
ED-MD
|
Coats TJ., Wilson AW., Xeropotamous N. Pre-hospital management of patients with severe thoracic injury. Injury: International J of the Care of the Injured 1995; 26(9):581-5. Medline
|
III
|
Supportive (Green)
|
Safety and efficacy
|
Patient
|
|
Schmidt U., Stalp M., Gerich T., et al. Chest tube decompression of blunt chest injuries by physicians in the field: Effectiveness and complications. J Trauma 1998; 44(1):98-101. Medline
|
III
|
Neutral (Yellow)
|
Mortality
|
Patient
|
ED-MD
|
Davis DP., Pettit K., Rom CD., et al. The safety and efficacy of prehospital needle and tube thoracostomy by aeromedical personnel. Prehosp Emerg Care 2005; 9(2):191-7. Medline
|
III
|
Neutral (Yellow)
|
correct performance of intervention
|
Patient
|
PH-Paramedic
|
Lairet JR., Bebarta VS., Burns CJ., Lairet KF., Rasmussen TE., Renz EM., et al. Prehospital interventions performed in a combat zone: a prospective multicenter study of 1,003 combat wounded. J Trauma Acute Care Surg 2012; 73(2S1):S38-42. Medline
|
III
|
Neutral (Yellow)
|
The primary objective of this study was to compare the infectious complication rate between emergency department
(ED) and prehospital TT.
|
Patient
|
|
Spanjersberg WR., Ringburg AN., Bergs EA., Krijen P., Schipper IB. Prehospital chest tube thoracostomy: Effective treatment or additional trauma? J Trauma 2005; 59(1):96-101. Medline
|
III
|
Opposes (Red)
|
Appropriateness
|
Process
|
PH-MD & CCT
|
Aylwin CJ., Brohi K., Davies GD., Walsh M. Pre-hospital and in-hospital thoracostomy: indications and complications. Ann R Coll Surg Eng 2008; 90:54-7. Medline
|
Needle Decompression
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Supportive (Green)
|
Efficacy
|
Patient
|
|
Aho JM., Thiels CA., El KM, et al. Needle thoracostomy: Clinical effectiveness is improved using a longer angiocatheter. The journal of trauma and acute care surgery 2016; 80(2):272-7. Medline
|
II
|
Supportive (Green)
|
24 hour mortality
|
Patient
|
PH-Paramedic
|
Muchnok D, Vargo A, Deeb AP, Guyette FX, Brown JB. Association of Prehospital Needle Decompression With Mortality Among Injured Patients Requiring Emergency Chest Decompression. JAMA Surg 2022. Medline
|
II
|
Supportive (Green)
|
Effective catheter placement for needle thoracotomy, prehospital
|
Process
|
PH-Paramedic
|
Osterman J, Kay AB, Morris DS, Evertson S, Brunt T, Majercik S. Prehospital decompression of tension pneumothorax: Have we moved the needle? Am J Surg 2022. Medline
|
II
|
Supportive (Green)
|
Success Rate
|
Process
|
PH-Paramedic & CCT
|
Robitaille-Fortin M, Norman S, Archer T, Mercier E. Prehospital Decompression of Pneumothorax: A Systematic Review of Recent Evidence. Prehosp Disaster Med 2021; 1–10. Medline
|
II
|
Neutral (Yellow)
|
Improvement in clinical status
|
Patient
|
|
Barton ED., Epperson M., Hoyt DB., et al. Prehospital needle aspiration and tube thoracostomy in trauma victims: A six-year experience with aeromedical crews. J Emerg Med 1995; 13(2):155-63. Medline
|
II
|
Neutral (Yellow)
|
Incidence of complications
|
Patient
|
ED-MD
|
Harris CT, Taghavi S, Bird E, Duchesne J, Jacome T, Tatum D. Prehospital Simple Thoracostomy Does Not Improve Patient Outcomes Compared to Needle Thoracostomy in Severely Injured Trauma Patients. Am Surg 2022; 31348221075746. Medline
|
II
|
Neutral (Yellow)
|
Distance from pleural space
|
Process
|
PH-Paramedic & CCT
|
Lesperance RN., Carroll CM., Aden JK., Young JB., Nunez TC. Failure Rate of Prehospital Needle Decompression for Tension Pneumothorax in Trauma Patients. Am Surg 2018; 84(11) 1750-5. Medline
|
II
|
Neutral (Yellow)
|
Mortality rate
|
Patient
|
PH-Paramedic
|
Sharrock MK, Shannon B, Garcia Gonzalez C, St Clair T, Mitra B, Noonan M, et al. Prehospital paramedic pleural decompression: A systematic review. Injury 2021. Medline
|
II
|
Neutral (Yellow)
|
Efficacy
|
Patient
|
PH-Paramedic
|
Waydhas C., Sauerland S. Pre-hospital pleural decompression and chest tube placement after blunt trauma: A systematic review. Resuscitation 2007; 72:11-15. Medline
|
III
|
Supportive (Green)
|
Survival
|
|
|
Bushby N., Fitzgerald M., Cameron P., et al. Prehospital intubation and chest decompression is associated with unexpected survival in major thoracic blunt trauma. Emerg Med Australas 2005; 17(5-6):443-9. Medline
|
III
|
Supportive (Green)
|
Improvement in vital signs
|
Patient
|
PH-Paramedic & CCT
|
Henry R, Ghafil C, Golden A, Matsushima K, Eckstein M, Foran CP, et al. Prehospital Needle Decompression Improves Clinical Outcomes in Helicopter Evacuation Patients With Multisystem Trauma: A Multicenter Study. J Spec Oper Med 2021; 21(1):49-54. Medline
|
III
|
Supportive (Green)
|
Dislodgement rate
|
Process
|
SIM
|
Leatherman ML., Held JM., Fluke LM., McEvoy CS., Inaba K., Grabo D., et al. Relative device stability of anterior versus axillary needle decompression for tension pneumothorax during casualty movement Preliminary analysis of a human cadaver model. The journal of trauma and acute care surgery 2017; 83(1) S136-41. Medline
|
III
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Sanson G., Di Bartolomeo S., Nardi G., et al. Road traffic accident with vehicular entrapment: incidence of major injuries and need for advanced life support. Eur J Emerg Med 1999; 6(4):285-91. Medline
|
III
|
Supportive (Green)
|
Mortality and morbidity
|
Patient
|
PH-Paramedic
|
Warner KJ., Copass MK., Bulger EM. Paramedic use of needle thoracostomy in the prehospital environment. Prehosp Emerg Care 2008; 12:162-8. Medline
|
III
|
Neutral (Yellow)
|
First pass success
|
Process
|
PH-Paramedic
|
Davis DP., Pettit K., Rom CD., et al. The safety and efficacy of prehospital needle and tube thoracostomy by aeromedical personnel. Prehosp Emerg Care 2005; 9(2):191-7. Medline
|
III
|
Neutral (Yellow)
|
Effect of needle thoracostomy (NT)
|
Patient
|
PH-Paramedic
|
Eckstein M., Suyehara D. Needle thoracostomy in the prehospital setting. Prehosp Emerg Care 1998; 2:132-5. Medline
|
III
|
Neutral (Yellow)
|
Success
|
Process
|
|
Kaserer A., Stein P., Simmen HP., Spahn DR., Neuhaus V. Failure rate of prehospital chest decompression after severe thoracic trauma. Am J Emerg Med 2017; 35(3):469-74. Medline
|
III
|
Neutral (Yellow)
|
correct performance of intervention
|
Patient
|
PH-Paramedic
|
Lairet JR., Bebarta VS., Burns CJ., Lairet KF., Rasmussen TE., Renz EM., et al. Prehospital interventions performed in a combat zone: a prospective multicenter study of 1,003 combat wounded. J Trauma Acute Care Surg 2012; 73(2S1):S38-42. Medline
|
III
|
Neutral (Yellow)
|
success
|
Patient
|
PH-Paramedic & MD
|
Musa J, Zielinski M, Hernandez M, Mohan A, Traynor M, Mahony C, et al. Tension pneumothorax decompression with colorimetric capnography: pilot case series. Gen Thorac Cardiovasc Surg 2022; 70(1):59–63. Medline
|
III
|
Neutral (Yellow)
|
Proper needle thoracostomy placement
|
Process
|
PH-Paramedic
|
Neeki MM, Cheung C, Dong F, Pham N, Shafer D, Neeki A, et al. Emergent needle thoracostomy in prehospital trauma patients: a review of procedural execution through computed tomography scans. Trauma Surg Acute Care Open 2021; 6(1):e000752. Medline
|
III
|
Neutral (Yellow)
|
Success rate
|
Process
|
ED-MD
|
Stevens RL., et al. Needle thoracostomy for tension pneumothorax: failure predicted by chest CT. Prehosp Emerg Care 2009; 13:14-7. Medline
|
III
|
Neutral (Yellow)
|
Mortality
|
Patient
|
PH-Paramedic
|
Weichenthal LA., Owen S., Stroh G., Ramos J. Needle Thoracostomy Does Changing Needle Length and Location Change Patient Outcome? Prehosp Disaster Med 2018; 33(3) 237-44. Medline
|
III
|
Opposes (Red)
|
Adverse outcomes
|
Patient
|
PH-Paramedic
|
Travis HJ, Andry GV, Rutner CC, et al. Prehospital Needle Decompression of Suspected Tension Pneumothorax: Outcomes and Consequences. Am Surg April 2024; 31348241241739. Medline
|
III
|
Opposes (Red)
|
Appropriate Indication
|
Process
|
PH-Paramedic & CCT
|
Vazquez GE, Calhoun JR, Fuchsen EA, et al. Needlessly Treated: Evaluation of Prehospital Needle Thoracostomy. J Trauma Nurs Sept 2024; 31(5):242-8. Medline
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Myers JC, Achay J, Limon D, et al. Evaluation of a Novel Needle Decompression Device Against Standard of Care: A Cadaveric Model. Mil Med Sept 2024. Medline
|
Thoracostomy
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic & CCT
|
Hannon L, St Clair T, Smith K, Fitzgerald M, Mitra B, Olaussen A, et al. Finger thoracostomy in patients with chest trauma performed by paramedics on a helicopter emergency medical service. Emerg Med Australas 2020 Aug;32(4):650-656. Medline
|
II
|
Neutral (Yellow)
|
Efficiency
|
Patient
|
PH-Paramedic
|
Sharrock MK, Shannon B, Garcia Gonzalez C, Clair TS, Mitra B, Noonan M, Fitzgerald PM, Olaussen A. Prehospital paramedic pleural decompression: A systematic review. Injury. 2021 Oct;52(10):2778-2786. doi: 10.1016/j.injury.2021.08.008. Epub 2021 Aug 11. PMID: 34454722. Medline
|
III
|
Supportive (Green)
|
Successful treatment
|
Process
|
PH-Paramedic & MD
|
Kaserer A, Stein P, Simmen HP, Spahn DR, Neuhaus V. Failure rate of prehospital chest decompression after severe thoracic trauma. Am J Emerg Med. 2017 Mar;35(3):469-474. doi: 10.1016/j.ajem.2016.11.057. Epub 2016 Nov 30. PMID: 27939518. Medline
|
III
|
Supportive (Green)
|
Survival to hospital discharge
|
Patient
|
PH-MD & CCT
|
Massarutti D, Trillò G, Berlot G, Tomasini A, Bacer B, D'Orlando L, Viviani M, Rinaldi A, Babuin A, Burato L, Carchietti E. Simple thoracostomy in prehospital trauma management is safe and effective: a 2-year experience by helicopter emergency medical crews. Eur J Emerg Med. 2006 Oct;13(5):276-80. doi: 10.1097/00063110-200610000-00006. PMID: 16969232. Medline
|
Ultrasound
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
I
|
Supportive (Green)
|
Accuracy
|
Process
|
PH-Paramedic
|
Griffiths E. Helicopter emergency medical services use of thoracic point of care ultrasound for pneumothorax: a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med 2021; 29(1):163. Medline
|
II
|
Supportive (Green)
|
Detection of pneumothorax
|
Process
|
ED-MD
|
Nagarsheth K., Kurek S. Ultrasound detection of pneumothorax compared with chest X-ray and computed tomography scan. Am Surg 2011; 77(4):480-4. Medline
|
II
|
Supportive (Green)
|
Prehospital U/S supported intervention.
|
Patient
|
PH-MD & CCT
|
O'Dochartaigh D., Douma M., Alexiu C., Ryan S., MacKenzie M. Utilization Criteria for Prehospital Ultrasound in a Canadian Critical Care Helicopter Emergency Medical Service Determining Who Might Benefit. Prehosp Disaster Med 2017; 32(5) 536-40. Medline
|
II
|
Supportive (Green)
|
Feasibility
|
Process
|
PH-Paramedic
|
Pietersen PI, Mikkelsen S, Lassen AT, Helmerik S, Jørgensen G, Nadim G, et al. Quality of focused thoracic ultrasound performed by emergency medical technicians and paramedics in a prehospital setting: a feasibility study. Scand J Trauma Resusc Emerg Med 2021; 29(1):40. Medline
|
II
|
Supportive (Green)
|
Detection of hemo/pneumothoraces
|
Process
|
ED-MD
|
Staub LJ., Biscaro RRM., Kaszubowski E., Maurici R. Chest ultrasonography for the emergency diagnosis of traumatic pneumothorax and haemothorax A systematic review and meta-analysis. Injury 2018; 49(3) 457-66. Medline
|
II
|
Supportive (Green)
|
Time of examination and on scene time
|
Process
|
PH-MD & CCT
|
Vianen NJ, Van Lieshout EMM, Vlasveld KHA, Maissan IM, et al. Impact of Point-of-Care Ultrasound on Prehospital Decision Making by HEMS Physicians in Critically Ill and Injured Patients: A Prospective Cohort Study. Prehosp Disaster Med. July 2023; 1-6. Medline
|
II
|
Neutral (Yellow)
|
Feasibility
|
Process
|
PH-Paramedic & MD
|
CB M, Ball M, RE C, MK R, Chrzan K, AR P. Ultrasound Use in the Prehospital Setting for Trauma: A Systematic Review. Prehosp Emerg Care 2021; 25(4):566–82. Medline
|
II
|
Neutral (Yellow)
|
Sensitivity and specificity
|
Process
|
ED-MD
|
Matsushima K, Khor D, Berona K, Antoku D, Dollbaum R, Khan M, et al. Double Jeopardy in Penetrating Trauma: Get FAST, Get It Right. World J Surg 2018; 42(1):99-106. Medline
|
II
|
Neutral (Yellow)
|
Diagnostic accuracy
|
Process
|
PH-Paramedic & CCT
|
Waydhas C, Prediger B, Kamp O, et al. Prehospital management of chest injuries in severely injured patients-a systematic review and clinical practice guideline update. Eur J Trauma Emerg Surg February 2024. Medline
|
II
|
Opposes (Red)
|
Sensitivity and false-negative rate
|
Process
|
In-Patient
|
Santorelli JE, Chau H, Godat L, Casola G, Doucet JJ, Costantini TW. Not so FAST-Chest ultrasound underdiagnoses traumatic pneumothorax. J Trauma Acute Care Surg 2022; 92(1):44–8. Medline
|
III
|
Supportive (Green)
|
PTX Identification
|
Patient
|
SIM
|
Brown SA, Carius BM, Monti JD, Robeck RS, Fritz DK. Combat Medic-Performed Auscultation Versus Thoracic Ultrasound Image Interpretation for Pneumothorax Detection: Look or Listen? Cureus Sept 2024; 16(9):e68657. Medline
|
III
|
Supportive (Green)
|
Diagnosis of pericardial effusion
|
Patient
|
PH-Paramedic
|
Heegarard W., et al. Prehospital ultrasound diagnosis of traumatic pericardial effusion. Acad Emerg Med 2009; 16(4):364. Medline
|
III
|
Supportive (Green)
|
Positive predictive value
|
Patient
|
|
Hoyer HX., Vogl S., Schiemann U., Haug A., Stolpe E., Michalski T. Prehospital ultrasound in emergency medicine: Incidence, feasibility, indications and diagnoses. Eur J Emerg Med 2010; 17(5):254-9 Medline
|
III
|
Neutral (Yellow)
|
Mortality
|
Patient
|
ED-MD
|
Jorgensen H., Jensen CH., Dirks J. Does prehospital ultrasound improve treatment of the trauma patient? A systematic review. Eur J Emerg Med 2010; 17(5):249-53. Medline
|
III
|
Neutral (Yellow)
|
Detection of pneumothorax
|
Process
|
SIM
|
Khalil PA, Merelman A, Riccio J, Peterson J, Shelton R, Meyers J, et al. Randomized Controlled Trial of Point-of-Care Ultrasound Education for the Recognition of Tension Pneumothorax by Paramedics in Prehospital Simulation. Prehosp Disaster Med 2021; 36(1):74-8. Medline
|
III
|
Neutral (Yellow)
|
Accuracy
|
Process
|
PH-Paramedic
|
Press GM, Miller SK, Hassan IA, Alade KH, Camp E, Junco DD, Holcomb JB. Prospective evaluation of prehospital trauma ultrasound during aeromedical transport. J Emerg Med. 2014;47(6):638-45 Medline
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Martinet C, Cungi PJ, Morin J. Usefulness of an Ultrasound-guided Prehospital Care for SCUBA Diving Accidents. Mil Med Aug 2024; 189(9-10):e2264-67. Medline
|