Page 100 - JSOM Spring 2021

FIGURE 1 PRISMA-adapted flowchart of the screening process.

Records identified with Records identified with
search strategy 1 (n = 3,653) search strategy 2 (n = 393)

(Records identified after
duplications excluded (n = 3,966)

Records screened Records excluded due to
(n = 3,966) exclusion criteria (n = 3,926)

Full-text articles assessed Full-text articles excluded due to
for eligibility (n = 40) exclusion criteria (n = 35)
• Reporting results of three-sided
dressings or other devices (n = 2)
• Use of chest seals for other
Full-text articles included in purpose then covering sucking
qualitative synthesis (n = 5) chest wounds (n = 1)
• Reviews/guidelines/no proper
experimental assessment of chest
seals (n = 16)
• Reporting quantitative use of
chest seals on the battlefield
without data about treatment
results (n = 1)
• Reporting incidence of
penetrating trauma and overall
results of their treatment (n = 15)

significant changes in at least four cardiorespiratory param- hemopneumothorax increased intrapleural pressure signifi-
eters, plus radiographic validation. The intrapleural pressure cantly, with decreases in respiratory volume, Pao , Svo , and
2
2
increased near to 0mmHg, while venous oxygen saturation cardiac output. All chest seals restored the intrapleural pres-
(Svo ), peripheral capillary oxygen saturation (Spo ) and par- sure and led to improved breathing and oxygenation, but there
2
2
tial pressure of oxygen (Pao ) decreased. There were no rele- was no improvement in the cardiocirculatory parameters. The
2
vant changes in cardiocirculatory parameters. Application of authors next injected a maximum of 2L of air into the swine
both vented and unvented chest seals led to a normalization models. The three laminar vented chest seals evacuated the air,
of values near to the baseline. After repeated infusions of air maintaining stable parameters with no development of a ten-
in the unvented chest seal model (Halo), the difference be- sion pneumothorax. There was a 25% incidence of tension
tween inspiratory and expiratory intrapleural pressure became pneumothorax with the flutter valve seals as a result of blood
smaller, and decreases in Svo , Spo , Pao , tidal volume, MAP, clotting from ineffective evacuation of air/blood. 31
2
2
2
and cardiac output were observed. The heart rate and the par-
tial pressure of carbon dioxide (Paco ) increased and, after In 2008, Arnaud et al. tested different chest seals for their ad-
16
2
an average 1,400mL of injected air, a tension pneumothorax herence on swine skin. To simulate battlefield conditions, they
was diagnosed. Some models experienced respiratory arrest. applied chest seals on the skin of swine soiled with different
A chest radiograph showed a total collapse of the lung and a environmental contaminants, such as blood and sand. The ad-
huge mediastinal shift. In contrast, no aggravation of clinical hesive performance was tested on both shaved and unshaved
conditions occurred with use of the Bolin chest seal. There was skin and after the chest seals had been stored in conditions
less lung collapse and mediastinal shift noted on these chest ranging from -19.5°C to 71.5°C. Three seals were excluded
radiographs. The authors’ conclusion was to advise the use of because of immediate inferior adhesive qualities in pretesting.
vented chest seals to prevent a tension pneumothorax when These were the Asherman, Sentinel, and Bolin XL. With the
the possibility of additional air entering the pleural space ex- exception of the Bolin chest seal, four chest seals (FastBreathe
ists (e.g., damage to the tracheobronchial system). 30 [V Development Group], HyFin, Russell, and SAM) showed
comparable results under these extreme temperatures. The re-
A 2017 study by Kheirabadi et al. used swine models to test sults showed that vertical stress on chest seals was much more
31
the efficacy of various vented chest seals. The HyFin, Rus- stressful than horizontal stress, especially with the additional
sell (Tac Med Solutions), and Sentinel were laminar vented contamination of blood and sand. They further advised that
seals, and the Bolin and SAM were flutter valve seals. The adhesive properties of chest seals, which were multifolded

96 | JSOM Volume 21, Edition 1 / Spring 2021