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of having additional peripheral channels, which can minimize Author Contributions
the effects of clotting on venting efficiency. A chest seal de- NW and JMA designed the methodology and performed study.
sign with more channel redundancy may mitigate the threat of NW collected the data. NW and JMA analyzed the data, inter-
blood clotting rendering the chest seal ineffective. preted the results, and prepared the manuscript. JMA super-
vised the study.
Limitations
There are several limitations in this study. which should be dis- Disclosures
cussed. The first of which is our model of a tension hemotho- The Mayo Foundation has a financial interest in technologies
rax, which was simplified for reproducibility. The use of water developed by some of the authors.
instead of blood in this study presents a few limitations. Using
water, which has a lower viscosity than blood, may have yielded I, Nathan Wells, attest on behalf of all authors, that we had
different results than if a more viscous fluid was used. These full access to the data of the study, conducted all data analyses
results should only be used as comparative findings between independently from the funding entity, and take complete re-
the tested chest seals. Additionally, while there were statistically sponsibility for the integrity and accuracy of the data reported
significant differences between chest seal flow rates, it is diffi- in the manuscript.
cult to conclude whether these differences would have clini-
cally significant impacts. These results can be used to suggest Funding
trends in flow rate performance among different designs, while Pneumeric, Inc. funded the research associated with the manu-
more realistic pneumothorax models are needed to test clini- script. Pneumeric, Inc. did not have access to analyze the data,
cally significant results of flow rates and prevention of tension edit, or have final review of the publication.
pneumothoraces. However, it should be noted that damage to
the intercostal artery can result in blood loss at a reported rate References
16
of 47–169mL/min. Additionally, air leak in pneumothoraces 1. National Safety Council. All injuries – overview. Injury Facts.
has been reported to be 97.08 (SD 65.27) mL/min. Thus, a Accessed March 7, 2025. https://injuryfacts.nsc.org/all-injuries/
17
overview/
flow rate improvement between chest seals of over 100mL/min, 2. Lundin A, Akram SK, Berg L, Göransson KE, Enocson A. Tho-
as seen in this study, could have a significant impact on the racic injuries in trauma patients: epidemiology and its influence
efficiency of fluid drainage. We were also unable to test for the on mortality. Scand J Trauma Resusc Emerg Med. 2022;30(1):69.
effect of clotting on chest seal performance. Previous studies doi:10.1186/s13049-022-01058-6
have used swine models to simulate either a pneumothorax or 3. Shorr RM, Crittenden M, Indeck M, Hartunian SL, Rodriguez A.
hemothorax. 11,12 Our in vitro model instead allowed the pres- Blunt thoracic trauma. Analysis of 515 patients. Ann Surg. 1987;
206(2):200–205. doi:10.1097/00000658-198708000-00013
sures to be controlled, enabling us to compare the performance 4. Keneally R, Szpisjak D. Thoracic trauma in Iraq and Afghanistan.
of the chest seals in extreme physiological use cases. While this J Trauma Acute Care Surg. 2013;74(5):1292–1297. doi:10.1097/
in vitro model is useful for comparing the fluid flow properties TA.0b013e31828c467d
of the chest seals, it is unable to simulate a clinical pneumo- 5. Hughes SM, Borders CW, Aden JK, Sjulin TJ, Morris MJ. Long-
thorax and test the ability of the chest seals to act as one-way term outcomes of thoracic trauma in U.S. service members
valves, which was not the purpose of the study. While the novel involved in combat operations. Mil Med. 2020;185(11):E2131–
E2136. doi:10.1093/milmed/usaa165
chest seals were made specifically for this study, the quality 6. McPherson JJ, Feigin DS, Bellamy RF. Prevalence of tension
of the novel chest seals may be different than the commercial pneumothorax in fatally wounded combat casualties. J Trauma.
chest seals. Although the plastic material used was comparable 2006;60(3):573–578. doi:10.1097/01.ta.0000209179.79946.92
to that of the commercial chest seals, different materials and 7. Magar J, Thakur D. Anesthesia for Thoracic Trauma. In: Ghandi
fabrication techniques may have an impact on the functionality M, Malde A, Kudalkar A, Kernik H, eds. A Practical Approach
of the novel chest seals. Finally, the potential degradation of to Anesthesia for Emergency Surgery. Jaypee Brothers Medical
Publishers; 2011:488–507.
chest seal performance over time was not measured. Previous 8. Kheirabadi BS, Terrazas IB, Koller A, et al. Vented versus un-
studies note the failure of certain chest seals occurs only after a vented chest seals for treatment of pneumothorax and prevention
certain period. While the results of the initial performance of of tension pneumothorax in a swine model. J Trauma Acute Care
12
these chest seals are important, the potential failure of certain Surg. 2013;75(1):150–156. doi:10.1097/TA.0b013e3182988afe
designs after extensive testing remains uncertain. 9. Kotora JG, Henao J, Littlejohn LF, Kircher S. Vented chest seals for
prevention of tension pneumothorax in a communicating pneu-
mothorax. J Emerg Med. 2013;45(5):686–694. doi:10.1016/j.
Conclusion jemermed.2013.05.011
10. Butler FK, Dubose JJ, Otten EJ, et al. Management of Open
In summary, six commercially available chest seals and eight Pneumothorax in Tactical Combat Casualty Care: TCCC Guide-
novel chest seals were tested for flow rate and channel satu- lines Change 13-02. J Spec Oper Med. 2013;13(3):81–86. doi:
ration at three different fluid pressures. Certain novel designs 10.55460/739G-PP0W
were comparable to the top-performing commercial chest seals 11. Arnaud F, Tomori T, Teranishi K, Yun J, McCarron R, Mahon R.
at all three pressures. Correlations between design characteris- Evaluation of chest seal performance in a swine model. Compar-
ison of Asherman vs. Bolin seal. Injury. 2008;39(9):1082–1088.
tics and improved chest seal performance were also observed. doi:10.1016/j.injury.2008.03.003
Designs with larger channel widths and more total channels 12. Kheirabadi BS, Terrazas IB, Miranda N, et al. Do vented chest
tended to result in higher flow rates and lower channel sat- seals differ in efficacy? An experimental evaluation using a swine
uration. Adhesive failure occurred when the valve design did hemopneumothorax model. J Trauma Acute Care Surg. 2017;83
not allow for efficient fluid drainage or with designs that had (1):182–189. doi:10.1097/TA.0000000000001501
little adhesive in the central chest seal area. A proposed opti- 13. Pleil JD, Ariel Geer Wallace M, Davis MD, Matty CM. The physics
mal chest seal design is one that has large channel widths and of human breathing: Flow, timing, volume, and pressure parameters
for normal, on-demand, and ventilator respiration. J Breath Res.
a high number of channels, while maintaining enough central 2021;15(4):10.1088/1752-7163/ac2589. doi:10.1088/1752-7163/
adhesive area to withstand high fluid pressure. ac2589

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