Page 83 - JSOM Fall 2021

TABLE 4 Data Extracted from Included Studies
Results
A Priori of Independent Independent Superior Inferior
Authors, Year Primary Outcome Model Outcome Variable(s) Variable(s) Details Performance Performance
Kheirabadi et al., Combined Swine DCR 20% MAP, Skin: shaved, clean, AI: 0.25L HYVCS, BCS, SCSV
2017 16 efficacy of CS 20% CO, or dried BI to wound tract: RCS, SCS
treating OHPNX, 30% MVO ; Thorax: air, blood 50mL
2
preventing TPNX INC 1mmHg IPP Wound: active
or 30% PAP bleeding tract
Arnaud et al., CS adhesiveness Swine % attached after Skin: clean, bloody, Horizonal peeling HYVCS, ACS, BCS,
2016 14 after storage peeling, vertical sand, dry, shaven, Vertical pull FBTS, RCS, BCSXL, SCS
at varying force unshaven SCSV
temperatures Storage: ambient,
cold, or hot

Kotora et al., Vent/valve Swine DCR 20% HR Thorax: air, blood AI: 60mL No significant N/A
2013 19 efficacy of CS or MAP BI to thorax: 10% difference
treating OHPNX, total volume
preventing TPNX
Kheirabadi et al., Vent vs. nonvented Swine 1mmHg IPP plus Thorax: air AI: 0.2L BCS HACS
2013 20 CS efficacy treating ≥ 4 of 5: DCR
OPNX preventing 20% MAP, 20%
TPNX CO, 20% TV,
or 30% MVO2;
ICR 30% PAP
Supinski et al., CS adherence and Human CS % TSA, loss Skin: perspiration, Skin: perspiration, ACS, BCS, SCS, WSK
2012 13 readherence after of adhesion body hair, burp dressing HACS,
burping within 1 cm of contaminants HYCS, RCS,
wound SCSV
Arnaud et al., CS vent/valve Swine Vent/Valve: Skin: dry, blood AI: 60mL Vent/Valve: Blood soiled
2008 17 efficacy treating DCR 20% HR soiled BI to thorax: ACS, BCS skin: ACS
OPNX preventing or MAP Thorax: air, blood 240mL Adherence:
TPNX and CS Skin: scored on a BCS
adhesion scale of 0 (poor)
to 3 (good)
CS, chest seal; OPNX, open pneumothorax, OHPNX, open hemopneumothorax; TPNX, tension pneumothorax; CO, cardiac output; HR, heart
rate; IPP, intrapleural pressure; MAP, mean arterial pressure; MVO , mixed venous oxygen saturation; PAP, pulmonary arterial pressure; TV,
2
tidal volume; AI, air increments; BI, blood increments; ACS, Asherman Chest Seal; BCS, Bolin Chest Seal; BCSXL, Bolin Chest Seal XL; FBTS,
FastBreathe Thoracic Seal; HACS, Halo Chest Seal; HYCS, Hyfin Chest Seal; HYVCS, Hyfin Vent Chest Seal; RCS, Russell Chest Seal; SCSV,

SAM Chest Seal with Valve; SCS, Sentinel Chest Seal; WSK, H&H Wound Seal Kit; TSA, total surface area; DCR, decrease of; ICR, increase of.

TABLE 5 Commercially Available Chest Seal Experimental Testing Supinksi et al. tested the adherence of eight chest seals on
Frequency healthy, human volunteers with a simulated wound to their
Number of Studies Testing Each Chest Seal chest and back. Supinksi et al. simulated combat conditions
13
Prevention of Tension and wound contaminants with exercise, canned condensed
Adherence (Nonocclusive) Pneumothorax (Nonocclusive) milk, and sand. A randomized chest seal was centered over the
Asherman Chest Seal 3 Asherman Chest Seal 1 wound and remained in place for 30–40 minutes before being
Bolin Chest Seal 3 Bolin Chest Seal 2 visually evaluated for separation from the skin. Supinksi et al.
Bolin Chest Seal XL 1 Bolin Chest Seal XL 0 then evaluated readherence after a simulated wound “burp-
13
17
FastBreathe Thoracic Seal 1 FastBreathe Thoracic Seal 0 ing.” Arnaud et al.’s 2008 study assessed the adherence of
Hyfin Vent Chest Seal 2 Hyfin Vent Chest Seal 2 two chest seals on a swine model by placing a randomized

chest seal over a surgically created open pneumothorax sur-
Russell Chest Seal 2 Russell Chest Seal 1 rounded by dry or blood-soiled skin. Arnaud et al. recorded

17
SAM Chest Seal with Valve 3 SAM Chest Seal with Valve 2 the force needed to separate the chest seal from the swine skin

Sentinel Chest Seal 3 Sentinel Chest Seal 2 using a 0-3 scale described by Khan and Peh. Arnaud et al.’s

18
Prevention of Tension 2016 study focused on the adherence of seven chest seals on
14
Adherence (Occlusive) Pneumothorax (Occlusive) uninjured swine skin after being stored at ambient (20–22°C),
Halo Chest Seal 1 Halo Chest Seal 1 cold (–19.5 ± 1.3°C), or hot (71.5 ± 2.0°C) temperatures. Af-

14

Hyfin Chest Seal 1 Hyfin Chest Seal 0 ter storage at either cold or hot temperatures, the randomized

H&H Wound Seal Kit 1 H&H Wound Seal Kit 0 chest seals were allowed to return to ambient temperature then
affixed to skin that was either clean dry shaven, clean dry un-
previously cited in multiple publications, to include the Com- shaven, unshaven covered in blood, unshaven covered in dry
mittee for Tactical Combat Casualty Care treatment and sand, or unshaven covered with blood and sand.
device recommendations. 13–16 Research manuscripts from Ar-
naud et al. in 2008 and 2016, and Kheirabadi et al. in 2017, Supinksi et al. evaluated each chest seal based on percent adher-
tested adherence on swine models with varying designs. 14,16,17 ence and whether the devices exhibited loss of adhesion within
Chest Seals and Tension Pneumothorax Prevention | 81