Page 80 - JSOM Fall 2021

Efficacy of Commercial Chest Seal Adherence

and Tension Pneumothorax Prevention
A Systematic Review of Quantitative Studies

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Roland Paquette, PA-C, MPAS *; Meredith Quinene, DHSc, MPAS, PA-C ;
Lorne Blackbourne, MD, FACS ; Paul Allen, PA-C, DSc
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ABSTRACT
Background: Penetrating thoracic injuries account for an es- isolated to urban and combat environments. The wilderness
sential subset of battlefield and civilian injuries that result medicine community also recognizes the importance of chest
in death. Current recommendations are to use commercially trauma in austere environments. 4,5
available nonocclusive chest seals. We review current evidence
for which chest seal(s) is likely to be the most effective in treat- For almost a century, recommendations for the management
ing open pneumothoraces. Methods: A systematic review was of open pneumothoraces have included specialized wound
conducted in accordance with the PRIMSA 2009 standard dressings due to the unique physiologic requirements of the
systematic review methodology, except where noted. The data- thoracic cavity. Current recommendations are to use nonocclu-
bases Pubmed, MEDLINE, CINAHL, Scopus, and gray sources sive chest seals when available to improve patient survival.
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were searched for all English-language, full-manuscript, ex- The commercial market has responded, and an Internet search
perimental, quantitative studies of humans and animals con- showed 14 commercially available occlusive and nonocclusive
cerning seal adherence or their efficacy at preventing tension chest seals with conflicting marketing claims regarding their
pneumothoraces published between 1990 and 2020. A numer- effectiveness (Table 1).
ical analysis was used to provide the consensus recommenda-
tion. Results: Of 683 eligible identified articles [PubMed 528 TABLE 1 Commercially Available Chest Seals
(77.3%), Scopus 87 (12.7%), CINAHL 67 (9.8%), one (0.1%) Nonocclusive Occlusive
unpublished], six (0.9%) articles were included. Synthesis of all Asherman Chest Seal (Teleflex, H&H DualSeal Chest Seal

studies’ results suggests a consensus recommendation for the Morrisville, NC) (H&H, Ordinary, VA)
Hyfin Vent Chest Seal and Russell Chest Seal. These two were Bolin Chest Seal (H&H, FoxSeal (MedTrade Products
the most effective chest seals, as previously investigated in a Ordinary, VA) LTD., Crewe, UK)
quantifiable, experimental study. Conclusion: While chest seals Bolin Chest Seal XL (H&H, Halo Chest Seal (Curaplex,

are recommended in civilian and military prehospital medicine Ordinary, VA) Dublin, OH)
to improve patient survival, current evidence concerning the in- FastBreathe Thoracic Seal Hyfin Chest Seal (North

dividual device’s efficacy is limited. Further scientific, quantita- (FastTrack Medical Solutions, American Rescue, Greer, SC)
tive research is needed to clarify which commercially available Eden Prairie, MN)

chest seals are most effective and provide patients with pene- Halo Vent Chest Seal (Curaplex, SAM Non-Valved (SAM
trating chest trauma the best possible method for preventing or Dublin, OH) Medical, Wilsonville, OR)

mitigating tension pneumothoraces. Hyfin Vent Chest Seal (North H&H Wound Seal Kit (H&H,
American Rescue, Greer, SC) Ordinary, VA)

Keywords: pneumothorax; chest seal; chest trauma; tactical Russel Chest Seal (Tactical
combat casualty care; advanced trauma life support; systematic Medical Solutions, Anderson, SC)
review SAM with valve (SAM Medical,

Wilsonville, OR)
SAM -Valved 2.0 (SAM Medical,

Introduction Wilsonville, OR)
Sentinel Chest Seal (Prometheus

Penetrating thoracic injuries account for an essential subset of Medical Ltd, Herefordshire, UK)
battlefield and civilian injuries. From 2003 to 2011, 2,048 US
military members sustained combat-related, nonlethal thoracic The efficacy of a chest seal is directly related to its ability to
injuries, 12.9% of which experienced an open pneumothorax. improve patient mortality when used to treat penetrating chest
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Penetrating chest trauma is not confined to the battlefield. trauma. To improve patient mortality, a chest seal needs two
In 2011, of the 512 trauma-related deaths in Miami-Dade essential attributes, to remain physically located over a wound
County, Florida, 18.6% died from potentially survivable chest and to mitigate the deleterious progression of an open pneu-
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injuries. A study of 12 civilian mass shootings demonstrated mothorax to a tension pneumothorax. These two attributes
that, of the victims who died with potentially survivable in- should function at the same time and remain intact when ex-
juries, 88.9% died with chest trauma leading to respiratory posed to common trauma contaminants such as blood, perspi-
impairment or tension pneumothoraces. Chest trauma is not ration, dirt, and fragments of tissue.
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*Correspondence to PaquetteR@uthscsa.edu
1 Roland Paquette, Dr Meredith Quinene, and Dr Paul Allen are affiliated with the Department of Physician Assistant Studies, The University of
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Texas Health San Antonio; Roland Paquette is also affiliated with the Department of Emergency Medicine, The University of Texas Health San
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Antonio. Dr Lorne Blackbourne is trauma medical director at the Houston Northwest Medical Center.
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