Page 82 - JSOM Fall 2021

FIGURE 1 Prisma diagram. TABLE 3 Methodological Characteristics of Included Studies
Characteristics N (%)
Records identified through Records identified from
database searching gray sources Study model
(n = 682) (n = 1) Human 1 (16)
Swine 5 (83)
Study purpose
Records after duplicates removed Adherence 2 (33)
(n = 605) Vent/valve efficacy 1 (16)
Overall effectiveness 2 (33)
Records did not Independent investigation of adherence and 1 (16)
Records screened meet inclusion vent/valve efficacy in same study
(n = 605) criteria or met Year of publication
exclusion criteria
(n = 599) Unpublished 1 (16)
2007–2010 1 (16)
2011–2014 2 (33)
Full-text articles
Reference list assessed for Full-text articles 2015–2018 2 (33)
search eligibility excluded
(n = 1) (n = 7) (n = 1) *Percentage column does not equal 100% due to rounding.
chest seals have been experimentally tested, nor did the in-
cluded studies test the same chest seals (Table 5). Each chest
seal’s total score, weighted scores, primary outcome, sample
Studies included in size, and associated citation are included in Table 6.
qualitative synthesis
(n = 6)
Table 7 provides each chest seal’s scores concerning their per-
formance in adherence or vent/valve function. Table 6 includes
used to amalgamate extremely heterogeneous data from het- more data points for each device tested as compared to Table 7
erogeneous studies. A weighted score of one (1) to three (3) because it has expanded varying experimental iterations found
12
was used to score chest seal performance based on the report- within the included studies.
ing study’s results. A chest seal that was reported by the origi-
nal investigator to have superior performance received a score Four studies tested adherence as a primary outcome. Of the
of three (3). A chest seal that was excluded from further study chest seals tested, the FastBreathe Thoracic Seal (Fast Track
or deemed to have failed received a score of one (1), and a chest Medical Solutions LLC, www.fasttrackmedicalsolutions.com,
seal that was successful but not found to be statistically supe- Hyfin Vent Chest Seal (North American Rescue, www.narescue

rior received a score of two (2). Each chest seal was assigned .com), and SAM Chest With Valve Seal (SAM Medical, www
a weighted score for each of studies included in this review. A .sammedical.com) had equally superior performance (mean 3,
total score was calculated as a mean of each chest seal’s indi- standard deviation (SD) 0) (Table 7).
vidual scores. Chest seals that were not tested for adherence or
function were given a null value and were not assigned a to- Three studies tested the device’s ability to avoid predefined ten-
tal score. A one-way ANOVA with Tukey posthoc testing was sion pneumothorax-related parameters as a primary outcome.
used to test for statistical significance of the aggregated mean Of the chest seals tested, the Asherman Chest Seal (Teleflex

weighted scores using SPSS version 26 (IBM, https://www.ibm Medical, www.teleflex.com), Russell Chest Seal (Prometheus
.com/products/spss-statistics). A numerical ranking analysis Medical Ltd., www.prometheusmedical.co.uk), and Sentinel
was conducted using the total scores for each device to answer Chest Seal (Prometheus Medical Ltd, www.prometheusmedical
the objective of this study and provide consensus recommenda- .co.uk) had equally superior performance (Mean 3, SD 0) (Ta-
tions for overall chest seal effectiveness. ble 7).

To synthesize the results across the heterogeneous studies, an-
Results
swer the research questions, and provide a consensus state-
Search Results and Study Characteristics ment, an overall score was calculated for each device. Chest
The systematic search revealed a total of 682 eligible refer- seals not tested for both adherence and vent/valve function
ences [PubMed 528 (77.4%), Scopus 87 (12.8%), CINAHL 67 were not eligible to be recommended. There were no statisti-
(9.8%) and two additional studies were identified by review of cally significant differences between the chest seal’s total score
the reference lists (Figure 1). Of the 533 nonduplicate articles, as determined by a one-way ANOVA [F(5,26) = 1.288, p =
seven (1.0%) were initially selected for full-text review. One 0.299] with α = 0.05 due to a limited data set. Ordinal rank-
article was excluded during the full article review. Six (0.9%) ing analysis of all the total scores suggests a consensus rec-
relevant quantitative articles were found that evaluated chest ommendation for the Hyfin Vent Chest Seal and the Russell
seal effectiveness at treating open pneumothoraces (Table 3). Chest Seal, both with total scores of 2.75, as being the most
effective chest seals previously investigated in a quantifiable,
Aggregated Results experimental study (Table 7).
The objective of this review was to identify which chest seals
are the most effective at treating open pneumothoraces sec- Adherence
ondary to penetrating trauma. Table 4 includes the character- Supinksi et al. was the only adherence study conducted on
istics of the included studies. Not all commercially available human participants and, despite being unpublished, has been

80 | JSOM Volume 21, Edition 3 / Fall 2021