Review of: Waydhas C, Sauerland S: "Pre-hospital pleural decompression and chest tube placement after blunt trauma: A systematic review." Resuscitation. 72(1):11 25, 2007.
The authors of this paper attempted to answer the following questions related to the diagnosis and treatment of pneumothorax in the out-of-hospital setting. What are the diagnostic requirements and the accuracy for pneumothorac and tension pneumothorax? What are the indications for emergent pleural decompression? What is the best technique? And, is there a role for chest tube placement?
They ranked the studies and independently categorized the level of evidence from level 1 to 5, then graded it A (Level 1), B (Level 2 and 3), and C (Level 4 and 5). They make the following recommendations.
This is a very interesting article, particularly when taken in context with the following statement from Dr. Ken Mattox at the Baylor College of Medicine. He said, "There is indeed a lot of emotion relating to the ability to perform a technical assault on a patient, including needle decompression in the field. I have found NO, I repeat NO, data which were prospectively collected in a randomized fashion which justifies this dangerous practice. I would strongly recommend that prehospital chest decompression by ANYONE by any method be eliminated until appropriate evidenced based data exist." While he made that statement 10 years ago, I suspect he still feels the same way.
Unfortunately, despite providing numerous and sometimes conflicting recommendations, the authors failed to answer the real question. "Is there a clearly defined role for needle decompression in EMS?" Furthermore, it must be noted that the authors are from Germany, and their perspective of the scope and practice of prehospital medicine may differ significantly from that of their American counterparts. And finally, it is difficult to accept the opinion of two authors in determining the level of evidence of the literature. Generally, large expert panels are required to come to consensus on the value of individual research result.
With all of this said, I hope this paper spurs further debate and research on this rarely used but potentially life-saving procedure.