systematic litterature search with sorting prehospital ... · norsk tittel prehospital...

2017

SYSTEMATIC LITTERATURE SEARCH WITH SORTING

Prehospital emergency thoracotomy in traumatic cardiac arrest

REPORT

Title Prehospitalemergencythoracotomyintraumaticcardiacarrest:sys‐

tematicliteraturesearchwithsorting

Norsktittel Prehospitalnødtorakotomivedtraumatiskhjertestans:systematisk

litteratursøkmedsortering

Institution TheNorwegianInstituteofPublicHealth

(Folkehelseinstituttet)

CamillaStoltenberg,directorgeneral

Authors ElisabetHafstad(projectcoordinator),senioradvisor,TheNorwegian

InstituteofPublicHealth

TorunnElisabethTjelle,researcher,TheNorwegianInstituteofPublic

Health

IngvilSæterdal,researchdirector,TheNorwegianInstituteofPublic

Health

ISBN 978-82-8082-848-4

Publicationtype Systematicliteraturesearchwithsorting(litteratursøkmedsortering)

Numberofpages 14(22includingappendices)

Commissioner OrderingForumRHFofTheNationalSystemforManagedIntroduc‐

tionofNewHealthTechnologieswithintheSpecialistHealthService

inNorway

MeSHterms Thoracotomy;Pre‐HospitalCare;EmergencyMedicalServices;Tho‐

racicInjury;HeartInjuries;HeartArrest;Resuscitation

Citation HafstadE,TjelleTE,SæterdalI.Prehospitalemergencythoracotomy

intraumaticcardiacarrest:systematicliteraturesearchwithsorting.

Oslo:TheNorwegianInstituteofPublicHealth,2017.

TheNorwegianInstituteofPublicHealth

Oslo,August2017

2 Key Messages

KeyMessages

TheNationalSystemforManagedIntroductionofNewHealth

TechnologieswithintheSpecialistHealthServiceinNorwaycom‐

missionedasystematicliteraturesearchfollowedbysortingof

relevantresearchon"Prehospitalemergencythoracotomyintrau‐

maticcardiacarrest"fromTheNorwegianInstituteforPublic

Health,DivisionforHealthServices.Theobjectivewastoidentify

existingliterature/researchonthesubjectasabackgroundfora

potentialhealthtechnologyassessment.

Method

Wedevelopedsearchstrategiesandconductedsearchesineight

databasesinMarch2017.Twoinvestigatorsindependentlyre‐

viewedandevaluatedtherelevanceofretrievedreferencesbased

onpredefinedinclusionandexclusioncriteria.

Results

Ourliteraturesearchesidentified2615referencesintotal.We

judged17ofthemaspotentiallyrelevant.Afterfulltextread‐

ing,weincludedsixarticles.

Wesortedthereferencesaccordingtotypeoftrauma;pene‐

tratingorblunt.

Allincludedarticlesareretrospectivecaseseriesreporting

dataforaround189patientstreatedbyhelicopteremergency

medicalservices/mobileintensivecareunitinUK(London),

theNetherlands,Belgium(Brussels),andJapan.(Thenumber

ofpatientsisuncertainduetooverlappingstudypopula‐

tions).

Title: Prehospital emergency thoracotomy in traumatic cardiac arrest: systematic literature search with sorting --------------------------------------------

Type of publication:

Systematic literature search with sorting A systematic literature search with sorting is the result of: - searches for relevant literature according to a search strategy - grouping the results, if relevant ------------------------------------------

Does not answer eve-rything: - No critical evaluation of study

quality - No analysis or synthesis of the

results - No recommendations ------------------------------------------

Publisher: The Norwegian Institute for Public Health, Division for Health Services, on request from Ordering Forum (Bestillerforum RHF). ------------------------------------------

Updated: Last search for studies: March 2017

3 Hovedfunn

Hovedfunn

Folkehelseinstituttet,Områdeforhelsetjenester,fikkviaNasjo‐

naltsystemforinnføringavnyemetoderispesialisthelsetjenes‐

tenioppdragavBestillerforumRHFåutføreetlitteratursøkmed

påfølgendesorteringavmuligrelevanteforskningspublikasjoner

omprehospitalnødtorakotomivedtraumatiskhjertestans.Form‐

åletmedoppdragetvaråkartleggehvaslagsdokumentasjonsom

foreliggerforbrukieneventuellseneremetodevurdering.

Metode

Viutarbeidetsøkestrategierforsystematiskelitteratursøkiåtte

databaser.Søkenebleutførtimars2017.Topersonergjennom‐

gikkuavhengigavhverandreidentifisertereferanserogvurderte

relevansiforholdtilinklusjonskriteriene.

Resultat

Litteratursøkeneidentifisertetotalt2615referanser.Vivur‐

derte17avdemsommuligrelevante.Etterfulltekstgjennom‐

gangbleseksavartikleneinkludert.

Visortertedeinkludertestudieneettertypetraume;penetre‐

rendeellerstump(ikke‐penetrerende)skade.

Alleinkludertestudiererretrospektivepasientseriersom

rapportererdatafraomtrent189pasienterbehandletav

(luft)ambulansetjenesteniStorbritannia(London),Neder‐

land,Belgia(Brussel)ogJapan.(Antalletpasientererusikkert

grunnetoverlappendepopulasjoner).

Tittel: Prehospital nødtorakotomi ved traumatisk hjertestans: litteratur-søk med sortering ------------------------------------------ Publikasjonstype:

Systematisk litteratursøk med sortering Systematisk litteratursøk med sortering er resultatet av å - søke etter relevant litteratur

ifølge en søkestrategi og - eventuelt sortere litteraturen i

grupper ------------------------------------------

Svarer ikke på alt: - Ingen kritisk vurdering av

studienes kvalitet - Ingen analyse eller

sammenfatning av resultatene - Ingen anbefalinger ------------------------------------------

Hvem står bak denne publikasjonen? Folkehelseinstituttet, Område for helsetjenester, har gjennomført oppdraget etter forespørsel fra Bestillerforum RHF. ------------------------------------------

Når ble litteratursøket utført? Søk etter studier ble avsluttet mars 2017.

4 Table of contents

Tableofcontents

KEYMESSAGES 2

HOVEDFUNN 3

TABLEOFCONTENTS 4

PREFACE 5

BACKGROUND 6

Objective 7

Systematicliteraturesearchwithsorting 7

METHOD 8

Literaturesearch 8

Inclusionandexclusioncriteria 8

Articleselection 9

RESULTS 10

Resultofsearch 10

Includedstudies 11

Summary 12

Considerations 12

REFERENCES 14

APPENDIX1–SEARCHSTRATEGIES 15

Searchlog 15

Searchstrategies 16

APPENDIX2–EXCLUDEDSTUDIES 21

Excludedstudies 21

5 Preface

Preface

TheNationalSystemforManagedIntroductionofNewHealthTechnologieswithinthe

SpecialistHealthServiceinNorwaycommissionedaliteraturesearchfollowedbysort‐

ingofrelevantresearchon"Prehospitalemergencythoracotomyintraumaticcardiac

arrest"(ID2016_094)fromTheNorwegianInstituteforPublicHealth,Divisionfor

HealthServices.

Theprojectgroupconsistedof:

ElisabetHafstad(projectcoordinator),theNorwegianPublicHealthInstitute,Divi‐

sionforhealthservices

TorunnElisabethTjelle,researcher,theNorwegianPublicHealthInstitute,Division

forhealthservices

IngvilSæterdal,seniorresearcherandunitdirector,theNorwegianPublicHealth

Institute,Divisionforhealthservices

PerKristianHyldmo(headofTraumaUnit,SørlandetHospital)andOleChristian

Kleven,(generalandgastrointestinalsurgeon,InnlandetHospitalTrust)advisedusin

theprocessesofdecidinginclusionandexclusioncriteria,anddevelopingofsearch

strategies.EspenLindholm(headofAnesthesiologyDivision,VestfoldHospitalTrust)

andThomasGeisner(traumasurgeon,headofTraumaDivision,HaukelandUniversity

Hospital)peerreviewedthemanuscript.Wegreatlyappreciatetheircontributions.

ThisreportwillsupportOrderingForumoftheNationalSystemforManagedIntroduc‐

tionofNewHealthTechnologieswithintheSpecialistHealthServiceinNorwayinthe

decisiononwhetherthereisenoughevidencetoconductahealthtechnologyassess‐

ment.

Allauthorsandexpertssignedastandarddeclarationonconflictsofinterest.

SigneFlottorp

Departmentdirector

IngvilSæterdal

Unitdirector

ElisabetHafstad

Projectcoordinator

6 Background

Background

Athoracotomy(surgicalincisionofthechestwallintothepleuralspace)isthefirst

stepinseveralelectivethoracicsurgicalprocedures,forexamplelobectomyorpneu‐

monectomyforlungcancer.Asurgeoncarriesouttheprocedureintheoperatingthea‐

tre,withthepatientingeneralanesthesiainalateralpositiononanoperatingtable.

Thisreportconcernsprehospitalemergencythoracotomy,performedwiththepatient

inthesupineposition,oftenonthefloorortheground,andunderongoingcardiopul‐

monaryresuscitation(CPR).Theproceduremaybeindicatedwithintenminutesafter

lossofvitalsignsincardiacarrestandsuspectedtamponadecausedbychesttrauma.In

suchcases,theobjectivesofthethoracotomyaretorelievetamponade,closecardiac

wounds,andifnecessary,toprovidedirectheartmassage.Ifthenearestsurgicalinter‐

ventionismorethan5‐10minutesaway,someexperts,notablyLondonHelicopter

EmergencyServices,advocatetheproceduretobeperformedon‐scenebyanemer‐

gencyphysicianoranesthesiologist(1‐3).

Intheproposalforahealthtechnologyassessmentonprehospitalemergencythoracot‐

omy,itisdescribedthattheprocedureisyetnotanestablishedinterventioninNor‐

way.Ithasbeenperformedafewtimesinaprehospitalsetting,todatewithoutsurvi‐

vors(4).Atthistime,emergencymedicineisnotaregisteredspecialtybranchofNor‐

wegianmedicine.Hence,therearenoapprovedNorwegian"emergencyphysicians".If

establishedasanewinterventionhere,anesthesiologiststrainedinprehospitalcritical

carewouldbetheonescarryingouttheprocedure.Introducingprehospitalemergency

thoracotomyinNorwaywouldrequiresystematiceducationandtrainingofasufficient

numberofqualifiedpersonnelasdescribedabove;asystemtosecureavailabilityand

handlingofnecessarysurgicalinstrumentsatalltimes;immediateaccesstotrauma

centerorthoraxsurgeryunitfordefinitivehandlingoftheinjuredpatientandmore.

Theproposalestimatestherewouldberoughlytenprehospitalemergencythoracoto‐

miesperyearperformedifintroducedasaninterventioninNorway(4).

Emergencyresuscitativethoracotomyperformedon‐sceneisacontroversialmatterin

Norwegianmedicine.Ontheonehand,itisethicallychallengingtodenyapatientpo‐

tentiallylife‐savingtreatment(5).Ontheotherhand,resourcesneededtoestablishand

maintainemergencyresuscitativethoracotomyasaninterventionusedinaprehospital

settingcouldbespentelsewhere(6;7).

7 Background

ItisataskfortheDecisionForumoftheNationalSystemforManagedIntroductionof

NewHealthTechnologieswithintheSpecialistHealthServiceinNorwaytomakeade‐

cisiononwhethertointroducetheinterventionornot.

Objective

Thepurposeofthepresentreportistofindandbrieflypresent,availableresearchon

prehospitalemergencyresuscitativethoracotomyfortraumaticcardiacarrest.TheDe‐

cisionForumoftheNationalSystemforManagedIntroductionofNewHealthTechnol‐

ogieswithintheSpecialistHealthServiceinNorway,willusethislistasapreliminary

documentationtodecideifahealthtechnologyassessmentonthismatterisadvisable.

Systematicliteraturesearchwithsorting

Forasystematicliteraturesearchwithsortingassignment,weconductsystematic

searchesfortheissueathand.Wefirstscreenthensorttheidentifiedreferencesbased

ontheassumedrelevanceoftitlesandabstracts.Wedonotassessthequalityofin‐

cludedarticles.Neitherdoweanalyze,summarizeanddiscusstheresults.

8 Method

Method

Literaturesearch

Wesystematicallysearchedthefollowingeightdatabases:

CINAHL

CochraneLibrary

Embase

Epistemonikos

MEDLINE

PubMed(subsetPubMednotMEDLINE)

SveMed+

WebofScience

Atrainedmedicallibrarian(EH)plannedandexecutedallthesearchesMarch2017.We

basedthesearchstrategiesontheinclusioncriteriaforpopulationandintervention,

usingtextwordsandtermsadaptedtothesyntaxandvocabularyofeachdatabase.An‐

otherlibrarianreviewedthestrategiespriortoconductingthesearches.

WealsosearchedNationalGuidelineClearinghouseforguidelinesandregistersofon‐

goingtrials,systematicreviewsandhealthtechnologyassessments.

Appendix1providesthefullsearchstrategiesforalldatabases.

Inclusionandexclusioncriteria

Theinclusionandexclusioncriteriaweredefinedbasedontheproposalandwithad‐

vicefrommedicalexpertsinthefield.

Inclusioncriteria

Population Patientswithtraumaticcardiacarrest

Intervention Prehospitalemergencythoracotomy

Comparison Allotherinterventionsornointervention

Outcome Survival

Studydesign Studiesreportingresultsfrommorethanfivepatients

Exclusioncriteria

9 Method

Population Patientswithmedicalcardiacarrest;patientswiththoracicin‐

jurywithoutcardiacarrest

Intervention Thoracotomyperformedinhospital/emergencydepartmentor

traumacenter

Studydesign Studieswithoutdataorreportingresultsfromlessthanfivepa‐

tients

Articleselection

Twopersons(EHandTET)independentlyscreenedtitlesandabstractstoidentifypo‐

tentiallyrelevantarticlesaccordingtotheinclusioncriteria.Forasystematicliterature

searchwithsortingassignmentlikethis,weusuallyincludeorexcludearticlesbased

oninformationgiveninthetitlesandabstractsalone.However,sinceweexpectedto

includefewstudies,wedecidedtoobtainandreadthepotentiallyrelevantarticlesin

fulltextaswellandsupplyabriefsummaryintabularformoftheincludedstudies.We

basedourselectiononconsensus.Wewouldhaveconsultedathirdpersontosolveany

disagreement.Wedidnotcriticallyappraisethearticles.

10 Results

Results

Resultofsearch

Oursearchesretrieved3528recordsthatwereimportedintoandde‐duplicatedin

EndNoteX8bibliographicsoftware(ThomsonReuters,CA,USA).

From2615uniquereferences,weexcluded2598referencesjudgedirrelevantbasedon

titlesandabstracts.Wethenread17publicationsinfulltext.Ofthese,weincludedsix

andexcluded11studiesbasedonourpre‐definedinclusionandexclusioncriteria(fig‐

ure1).Wereportkeyinformationfromtheincludedstudiesintables1‐2.

Themainreasonsforexclusionwerethoracotomyforotherindicationsthantraumatic

cardiacarrest;procedureperformedinemergencydepartmentortraumacenter,and

casereports(lessthanfiveprehospitalthoracotomies).

Appendix2providesbibliographicdetailsandreasonforexclusionforthe11articles

afterfulltextscreening.

Figure1.Flowchartofidentifiedliterature.

11 Results

Includedstudies

Thesixincludedarticlesareallretrospectivecaseseries.Threeofthemreportdata

fromLondonHelicopterEmergencyServices(HEMS),onefromamobileintensivecare

unitinBrussels,onefromthehelicopteremergencyserviceofChibaPrefecture,Japan,

andonearticle,yettobepublished,fromtheDutchHelicopterEmergencyServices.

Someoftheincludedarticlesreportoutcomedatafromemergencythoracotomiesper‐

formedbothon‐sceneandinemergencydepartmentsoroperatingtheatres;cardiacar‐

rests/lossofpulsefromothercausesthanpenetratingorbluntchesttrauma,and

emergencythoracotomiesperformedforotherreasonsthancardiopulmonaryresusci‐

tation.Inthesummarytablesbelow,wehaveextracteddatarelevantforthoracotomies

performedon‐sceneforcardiacarrestfollowingpenetratingand/orblunttrauma(ta‐

ble1)andblunttraumaonly(table2).

Table1.Prehospitalemergencythoracotomyafterpenetratingorpenetrating/blunt

traumaAuthor/year

Datacollection

Setting Numberofpatients/population Outcomes

Athanasiou2004(1)

1994‐2002Retrospectivecaseseries

LondonHelicop‐terEmergencyServices

31prehospitalemergencythora‐cotomies"[…]ourpatientgroupincludedbothbluntandpenetratingtrauma[…]"

3survivors

Coats2001(2)



39prehospitalemergencythora‐cotomiesStabwounds:25Handgun:12Glass:2

4survivors,1withlong‐termdisabil‐ity

Davies2011(3)



71prehospitalemergencythora‐cotomies"victimsofstabwoundstothechest"

13survivors,10withgoodneurologicaloutcome

vanVledder2017(8)


DutchHelicopterEmergencySer‐vices(3of4HEMSoperators)

33prehospitalemergencythora‐cotomiesGunshotwounds:10Stabwounds:23

1survivorwithoutneu‐rologicaldamage

Table2.PrehospitalemergencythoracotomyafterblunttraumaAuthor/year

Datacollection

Setting Numberofpatients/population Outcomes

Matsumoto2009(9)


HelicopterEmer‐gencyMedicalService,ChibaPrefecture,Japan

34prehospitalemergencythora‐cotomies

Nosurvivors

12 Results

Hachimi‐Idrissi1997(10)


MobileintensivecareunitofUni‐versityHospitalofBrussels

6prehospitalemergencythoracot‐omies"Theoriginofthecardiacarrestwas[…]traumainsixpatients"Site:roadside(Weassumethisindicatesblunttraumaalthoughnotspecifiedinthetext).

Nosurvivors

Summary

Outof2615identifieduniquereferences,wefoundonlysixrelevantresearcharticles

reportingonprehospitalemergencythoracotomyfortraumaticcardiacarrest.Allstud‐

iesareretrospectivecaseseriesreportingdatafromhelicopteremergencymedicalser‐

vicesinUK(London–threearticles),theNetherlands,JapanandBelgium(mobilein‐

tensivecareunit).Allstudiesarewithoutcomparatorgroup.

Consideringoverlappingpopulations,thematerialreportssurvivaloutcomesfromat

themost149prehospitalthoracotomiesfortraumaticcardiacarrestcausedbypene‐

tratingtrauma.(Athanasiou2004:31patients(includinganuncertainnumberofblunt

traumacases,andprobablysomecasesofstabwoundsalsoinDavies2011);Coats

2001:14patients(39minus25stabwoundsoverlapinDavies2011);Davies2011:71

patients;vanVledder2017:33patients)

Twostudiesontraumaticcardiacarrestcausedbyblunttrauma,reportsurvivalout‐

comesin40patients(Matsumoto2009:34patients;Hachimi‐Idrissi1997:6patients).

Considerations

Afterreadingthearticles,wesuggestsomeaspectsforconsiderationbyourcommis‐

sioner,theOrderingForumRHF.Notethatourconsiderationsarelessonslearnedfrom

readingthematerialtodecidewhattoincludeinthereport.Wehaveneithercritically

appraisedthearticlesnoranalyzedtheresultsofincludedstudies.

a. Levelofevidence:Weonlyfoundsixsmallretrospectivepatientseriestoin‐

cludeinthisreport.Generally,wewouldprefermoredataandacomparative

studydesigntoevaluatetheeffectofanintervention.However,we

acknowledgethescarcityofeventsandthechallengesofconductingresearchin

aprehospitalemergencysetting,makingitunlikelytogainstrongevidencefor

prehospitalemergencythoracotomy.

b. Standardization:Thedecisionalgorithmsforwhentoperformemergencythor‐

acotomiesarepossiblynotuniformbetweenthestudies,andcompliancetothe

guidelinesmightvary.Surgicalmethodscouldalsodifferslightlybetweenstud‐

ies.

13 Results

c. Outcomes:Otheroutcomesthanthesolesurvivalafterprehospitalemergency

thoracotomiesmightberelevanttoexplore,forexampleanalysesofneurologic

outcomesofthesurvivors.Threeoutoffourincludedstudieswithsurvivors

mentionedneurologicstatus,butonlybriefly.Acoupleoftheincludedstudies

hadsurvivalassecondaryoutcomeandreturnofspontaneouscirculationas

primaryoutcome.

d. Ethicalandlegalaspects:Someofthearticlesweexcludeddealtwithethical

considerationstoboththeoperator,bystandersandpatients.Thisisnotanout‐

putofthepresentreport,neitherarelegalaspects.

e. Frequency:LookingatthearticlesfromLondon,adenselypopulatedcityof8‐9

millionpeople,Daviesetalreportonly71prehospitalthoracotomiesfortrau‐

maticcardiacarrestcausedbystabwoundsovera15‐yearperiod(3).We

thereforequestionthenumbermentionedintheproposalforahealthtechnol‐

ogyassessment,whichissuggestedtobe10peryearinNorway(4).

f. Organizationalaspectsandresourceuse:Afuturepotentialhealthtechnology

assessmentcouldaddressorganizationalandeconomicconsequencessuchas:

- personnelstaffingandscheduling;

- educationandtrainingofprehospitalcriticalcareanesthesiologiststo

carryouttheprocedure;

- systemsforhandlingandavailabilityofnecessaryinstrumentation;

- quickaccesstoandcollaborationwithtraumacentersorthoraxsurgery

unitsfordefinitivehandlingofthepatientafteraprehospital

emergencythoracotomy;

- continuedhealthcareforneurologicallyimpairedsurvivors.

14 References

References

1. Athanasiou T, Krasopoulos G, Nambiar P, Coats T, Petrou M, Magee P, et al. Emergency thoracotomy in the pre-hospital setting: a procedure requiring clarification. Eur J Cardiothorac Surg 2004;26(2):377-86.

2. Coats TJ, Keogh S, Clark H, Neal M. Prehospital resuscitative thoracotomy for cardiac arrest after penetrating trauma: rationale and case series. J Trauma 2001;50(4):670-3.

3. Davies GE, Lockey DJ. Thirteen survivors of prehospital thoracotomy for penetrating trauma: a prehospital physician-performed resuscitation procedure that can yield good results. J Trauma 2011;70(5):E75-8.

4. Nasjonal kompetansetjeneste for traumatologi (NKT), Nasjonal kompetansetjeneste for prehospital akuttmedisin (NAKOS), Norsk anestesiologisk forening (NAF). ID2016_094 Forslag til nasjonal metodevurdering: Prehospital naudtorakotomi utført av anestesilegar i luftambulanseteneste. [Norwegian]Oslo: Sekretariatet for Nye Metoder [cited 01. March 2017]. Available from: https://nyemetoder.no/Documents/Forslag/ID2016_094_Prehospital%20nødtorakotomi.pdf

5. Ottestad W, Bredmose PB, Berve PO, Stave H, Farstad G, Wik L, et al. Prehospital torakotomi ved traumatisk hjertestans. [Norwegian]. Tidsskr Nor Laegeforen 2016;136(23-24):1964-5.

6. Glambek I, Wisborg T. Re: Prehospital torakotomi ved traumatisk hjertestans. [Norwegian]. Tidsskr Nor Laegeforen 2017;137(3):168.

7. Söreide K, Vetrhus M, Weber C. Etikk og estetikk ved prehospital torakotomi. [Norwegian]. Tidsskr Nor Laegeforen 2017;137(4):266-7.

8. van Vledder MG, van Waes OJF, Kooij FO, Peters JH, van Lieshout EMM, Verhofstad MHJ. Out of hospital thoracotomy for cardiac arrest after penetrating thoracic trauma. [accepted manuscript]. Injury.

9. Matsumoto H, Mashiko K, Hara Y, Kutsukata N, Sakamoto Y, Takei K, et al. Role of resuscitative emergency field thoracotomy in the Japanese helicopter emergency medical service system. Resuscitation 2009;80(11):1270-4.

10. Hachimi-Idrissi S, Leeman J, Hubloue Y, Huyghens L, Corne L. Open chest cardiopulmonary resuscitation in out-of-hospital cardiac arrest. Resuscitation 1997;35(2):151-6.

15

Appendix1–Searchstrategies

Searchlog

Nameofdatabase Hitsexported

toEndNote

Hitsafter

deduplication

inEndNote

Effectivenessandsafety

CINAHL 193 80

CochraneLibrary:CDSR(5;Reviews1+

Protocols4),OtherReviews(3),Trials

(29),TechnologyAssessments(0)

37 22

Embase 1144* 1087

Epistemonikos 15 1

MEDLINE 1361* 1258

PubMed(pubmednotmedline) 63 3

SveMed+ 12 8

WebofScience 703 155

Total 3528 2614

Guidelines

NationalGuidelineClearinghouse 14**

Ongoingprojectsandtrials

ClinicalTrials(US) 7**

ICTRP(WHO) 3**

PROSPERO 5**

POPdatabase 6**

*AfterdeduplicationinOVID

**Screenedonline–notexportedtoEndNote

16

Searchstrategies

Bibliographicdatabases

Embase<1974to2017March30>

1 Wound/

(Thorax)

trauma

2 GunshotInjury/

3 KnifeCut/

4 StabWound/

5 ThoraxPenetratingTrauma/

6 ThoraxBluntTrauma/

7 PenetratingTrauma/

8 or/1‐7

9 (trauma*orwound*orinjur*orpenetrat*ornon‐penetrat*orbluntorgun‐

shot*orstaborstabsorstabbingorstabbed).tw,kw.

10 Thoracotomy/ Thoracot‐

omy11 ThoraxSurgery/

12 Thorax/su

13 Pleura/su

14 or/10‐13

15 (thoracotom*OR(openchestADJ3(massage*ORcompress*ORresuscitat*))

OROCCPRORpleurotom*).tw,kw.

16 FirstAid/ Prehospital

setting17 EmergencyTreatment/

18 EmergencyCare/

19 Ambulance/

20 AirMedicalTransport/

21 EmergencyHealthService/

22 EmergencyMedicine/

23 MilitaryMedicine/

24 or/16‐23

17

25 (prehospitalORpre‐hospitalORout‐of‐hospitalORemergencyORambu‐

lance*ORhelicopter*ORaeromedicalORaero‐medicalORextra‐hospitalOR

preclinic*ORpre‐clinic*OR"atthesite"ORfieldORsceneORen‐routeOR

transitORparamedic*ORroadside).tw,kw

26 (editorialorletterornote).pt.

27 ((8or9)and(14or15)and(24or25))not26

28 (((Wound/ORGunshotInjury/ORKnifeCut/ORStabWound/ORThorax

PenetratingTrauma/ORThoraxBluntTrauma/ORPenetratingTrauma/)

OR(trauma*ORwound*ORinjur*ORpenetrat*ORnon‐penetrat*ORblunt

ORgunshot*ORstabORstabsORstabbingORstabbed).tw,kw.)AND((Thor‐

acotomy/ORThoraxSurgery/ORThorax/suORPleura/su)OR(thora‐

cotom*OR(openchestADJ3(massage*ORcompress*ORresuscitat*))OR

OCCPRORpleurotom*).tw,kw.)AND((FirstAid/OREmergencyTreatment/

OREmergencyCare/ORAmbulance/ORAirMedicalTransport/OREmer‐

gencyHealthService/OREmergencyMedicine/ORMilitaryMedicine/)OR

(prehospitalORpre‐hospitalORout‐of‐hospitalORemergencyORambu‐

lance*ORhelicopter*ORaeromedicalORaero‐medicalORextra‐hospitalOR

preclinic*ORpre‐clinic*OR"atthesite"ORfieldORsceneORen‐routeOR

transitORparamedic*ORroadside).tw,kw.)NOT(editorialORletterOR

note).pt)useoemezd

All‐in‐one

search

block

CINAHL

(((MH"WoundsandInjuries+"))ORTI(trauma*ORwound*ORinjur*ORpenetrat*OR

non‐penetrat*ORbluntORgunshot*ORstabORstabsORstabbingORstabbed)OR

AB(trauma*ORpenetrat*ORwound*ORinjur*ORnon‐penetrat*ORbluntORgun‐

shot*ORstabORstabsORstabbingORstabbed))AND(((MH"Thoracotomy")OR(MH

"ThoracicSurgery")OR(MH"Thorax/SU")OR(MH"Pleura/SU"))ORTI(thoracotom*

OR(openchestN2(massage*ORcompress*ORresuscitat*))OROCCPRORpleu‐

rotom*)ORAB(thoracotom*OR(openchestN2(massage*ORcompress*ORresusci‐

tat*))OROCCPRORpleurotom*))AND(((MH"EmergencyTreatment+")OR(MH

"EmergencyMedicalServices")OR(MH"EmergencyCare")OR(MH"Aeromedical

Transport")OR(MH"Ambulances")OR(MH"PrehospitalCare")OR(MH"Military

Medicine"))ORTI(prehospitalORpre‐hospitalORout‐of‐hospitalORemergencyOR

ambulance*ORhelicopter*ORaeromedicalORaero‐medicalORextra‐hospitalORpre‐

clinic*ORpre‐clinic*OR"atthesite"ORfieldORsceneORen‐routeORtransitORpara‐

medic*ORroadside)ORAB(prehospitalORpre‐hospitalORout‐of‐hospitalORemer‐

gencyORambulance*ORhelicopter*ORaeromedicalORaero‐medicalORextra‐hospi‐

talORpreclinic*ORpre‐clinic*OR"atthesite"ORfieldORsceneORen‐routeOR

18

transitORparamedic*ORroadside))NOTPT(commentaryOReditorialORletterOR

response)

CochraneLibrary

inCochraneReviews(Reviewsonly)andTrials

([mh"WoundsandInjuries"]OR(trauma*ORwound*ORinjur*ORpenetrat*ORnon‐

penetrat*ORbluntORgunshot*ORstabORstabsORstabbingORstabbed):ab,kw,ti)

AND(([mh^Thoracotomy]OR[mh^"ThoracicSurgery"]OR[mhThorax/su]OR[mh

^Pleura/su])OR(thoracotom*OR(openchestNEAR/3(massage*ORcompress*OR

resuscitat*))OROCCPRORpleurotom*):ab,kw,ti)AND(([mh"EmergencyMedicalSer‐

vices"]OR[mhAmbulances]OR[mh"EmergencyTreatment"]OR[mh"Emergency

Medicine"]OR[mh^"Evidence‐BasedEmergencyMedicine"]OR[mh^"FirstAid"]OR

[mh^"MobileHealthUnits"]OR[mh^"MilitaryMedicine"])OR(prehospitalORpre‐

hospitalORout‐of‐hospitalORemergencyORambulance*ORhelicopter*ORaeromed‐

icalORaero‐medicalORextra‐hospitalORpreclinic*ORpre‐clinic*OR"atthesite"OR

fieldORsceneORen‐routeORtransitORparamedic*ORroadside):ab,kw,ti)

inCochranereviews(Protocolsonly),OtherReviews,TechnologyAssessments

([mh"WoundsandInjuries"]OR(trauma*ORwound*ORinjur*ORpenetrat*ORnon‐

penetrat*ORbluntORgunshot*ORstabORstabsORstabbingORstabbed))AND(([mh

^Thoracotomy]OR[mh^"ThoracicSurgery"]OR[mhThorax/su]OR[mh^Pleura/su])

OR(thoracotom*OR(openchestNEAR/3(massage*ORcompress*ORresuscitat*))OR

OCCPRORpleurotom*))AND(([mh"EmergencyMedicalServices"]OR[mhAmbu‐

lances]OR[mh"EmergencyTreatment"]OR[mh"EmergencyMedicine"]OR[mh^"Ev‐

idence‐BasedEmergencyMedicine"]OR[mh^"FirstAid"]OR[mh^"MobileHealth

Units"]OR[mh^"MilitaryMedicine"])OR(prehospitalORpre‐hospitalORout‐of‐hospi‐

talORemergencyORambulance*ORhelicopter*ORaeromedicalORaero‐medicalOR

extra‐hospitalORpreclinic*ORpre‐clinic*OR"atthesite"ORfieldORsceneORen‐

routeORtransitORparamedic*ORroadside))

Embase

(((Wound/ORGunshotInjury/ORKnifeCut/ORStabWound/ORThoraxPenetrating

Trauma/ORThoraxBluntTrauma/ORPenetratingTrauma/)OR(trauma*ORwound*

ORinjur*ORpenetrat*ORnon‐penetrat*ORbluntORgunshot*ORstabORstabsOR

stabbingORstabbed).tw,kw.)AND((Thoracotomy/ORThoraxSurgery/ORThorax/su

ORPleura/su)OR(thoracotom*OR(openchestADJ3(massage*ORcompress*ORre‐

suscitat*))OROCCPRORpleurotom*).tw,kw.)AND((FirstAid/OREmergencyTreat‐

ment/OREmergencyCare/ORAmbulance/ORAirMedicalTransport/OREmergency

HealthService/OREmergencyMedicine/ORMilitaryMedicine/)OR(prehospitalOR

pre‐hospitalORout‐of‐hospitalORemergencyORambulance*ORhelicopter*ORaero‐

medicalORaero‐medicalORextra‐hospitalORpreclinic*ORpre‐clinic*OR"atthesite"

ORfieldORsceneORen‐routeORtransitORparamedic*ORroadside).tw,kw.)NOT

(editorialORletterORnote).pt)useoemezd

19

Epistemonikos

((trauma*ORwound*ORinjur*ORpenetrat*OR"non‐penetrating"ORbluntORgun‐

shot*ORstabORstabsORstabbingORstabbed))AND((thoracotom*OR"openchest

cardiacmassage"OR"openchestheartmassage"OR"openchestCPR"OR"openchest

resuscitation"OR"openchestcompression"OROCCPRORpleurotom*))AND((pre‐

hospitalOR"pre‐hospital"OR"out‐of‐hospital"OR"outofhospital"ORemergencyOR

ambulance*ORhelicopter*ORaeromedicalOR"aero‐medical"OR"extra‐hospital"OR

preclinic*OR"pre‐clinical"OR"atthesite"ORfieldORsceneOR"en‐route"ORtransit

ORparamedic*ORroadside))

OvidMEDLINE(R)EpubAheadofPrint,In‐Process&OtherNon‐IndexedCita‐

tions,OvidMEDLINE(R)DailyandOvidMEDLINE(R)1946toPresent

(((exp"WoundsandInjuries"/)OR(trauma*ORwound*ORinjur*ORpenetrat*OR

non‐penetrat*ORbluntORgunshot*ORstabORstabsORstabbingORstabbed).tw,kf.)

AND((Thoracotomy/ORThoracicSurgery/ORexpThorax/suORPleura/su)OR(thor‐

acotom*OR(openchestADJ3(massage*ORcompress*ORresuscitat*))OROCCPROR

pleurotom*).tw,kf.)AND((EmergencyMedicalServices/ORexpAmbulances/ORexp

EmergencyTreatment/ORexpEmergencyMedicine/OREvidence‐BasedEmergency

Medicine/ORFirstAid/ORMobileHealthUnits/ORMilitaryMedicine/)OR(prehospi‐

talORpre‐hospitalORout‐of‐hospitalORemergencyORambulance*ORhelicopter*

ORaeromedicalORaero‐medicalORextra‐hospitalORpreclinic*ORpre‐clinic*OR"at

thesite"ORfieldORsceneORen‐routeORtransitORparamedic*ORroadside).tw,kf.)

NOT(commentOReditorialORletterORnews).pt)useppez

PubMed(notMEDLINE)

(("WoundsandInjuries"[mh])OR(trauma*[tiab]ORwound*[tiab]ORinjur*[tiab]OR

penetrat*[tiab]ORnon‐penetrat*[tiab]ORblunt[tiab]ORgunshot*[tiab]ORstab[tiab]

ORstabs[tiab]ORstabbing[tiab]ORstabbed[tiab]))AND((Thoracotomy[mh]ORTho‐

racicSurgery[mh:noexp]ORThorax/su[mh]ORPleura/su[mh])OR(thoracotom*[tiab]

OR"openchestcardiacmassage"[tiab]OR"openchestheartmassage"[tiab]OR"open

chestCPR"[tiab]OR"openchestresuscitation"[tiab]OR"openchestcompres‐

sion"[tiab]OROCCPR[tiab]ORpleurotom*[tiab]))AND(("EmergencyMedicalSer‐

vices"[mh:noexp]ORAmbulances[mh]OREmergencyTreatment[mh]OR"Emergency

Medicine"[mh]OR"Evidence‐BasedEmergencyMedicine"[mh:noexp]ORFirst

Aid[mh:noexp]OR"MobileHealthUnits"[mh:noexp]OR"MilitaryMedicine"[mh:noexp)

OR(prehospital[tiab]ORpre‐hospital[tiab]ORout‐of‐hospital[tiab]ORemer‐

gency[tiab]ORambulance*[tiab]ORhelicopter*[tiab]ORaeromedical[tiab]ORaero‐

medical[tiab]ORextra‐hospital[tiab]ORpreclinic*[tiab]ORpre‐clinic*[tiab]OR"atthe

site"[tiab]ORfield[tiab]ORscene[tiab]ORen‐route[tiab]ORtransit[tiab]ORpara‐

medic*[tiab]ORroadside[tiab]))AND(pubmednotmedline[sb]ORpublisher[sb])

SveMed+

20

exp:"WoundsandInjuries"AND(noexp:ThoracotomyORnoexp:"ThoracicSurgery"OR

exp:"Thorax/su")

WebofScience

TS=((trauma*ORwound*ORinjur*ORpenetrat*OR"non‐penetrating"OR"blunt"OR

gunshot*OR"stab"OR"stabs"OR"stabbing"OR"stabbed")AND(thoracotom*OR

"openchestcardiacmassage"OR"openchestheartmassage"OR"openchestCPR"OR

"openchestresuscitation"OR"openchestcompression"OR"OCCPR"ORpleurotom*)

AND("prehospital"OR"pre‐hospital"OR"out‐of‐hospital"OR"emergency"ORambu‐

lance*ORhelicopter*OR"aeromedical"OR"aero‐medical"OR"extra‐hospital"ORpre‐

clinic*OR"pre‐clinic*"OR"atthesite"OR"field"OR"scene"OR"en‐route"OR"transit"

ORparamedic*OR"roadside"))

RefinedbyDOCUMENTTYPES:(ARTICLEORREVIEWORMEETINGABSTRACTOR

PROCEEDINGSPAPER)

Guidelines

NationalGuidelineClearinghouse

(prehospitalORpre‐hospitalORout‐of‐hospital)ANDthoracotom*

Ongoingprojectsandtrials

ClinicalTrials

thoracotomyANDtraumatic

InternationalClinicalTrialsRegistryPlatform(ICTRP)

thoracotomy*ANDtrauma*

EUnetHTAPlannedandOngoingProjectsdatabase

Search1:E04.928ThoracicSurgicalProcedures

Search2:thoracotom*

PROSPEROInternationalprospectiveregisterofsystematicreviews

(MeSHDESCRIPTORThoracotomyEXPLODEALLTREES)ORthoracotom*

21

Appendix2–Excludedstudies

Excludedstudies

Reference P I C O S Inclusion/exclusionCorralE,SilvaJ,SuarezRM,NunezJ,CuestaC.Asuccessfulemergencythoracotomyper‐formedinthefield.Resuscitation2007;75(3):530‐3.

Y Y Y Y N Exclusion.Althoughtheab‐stractreferstosixcases,thearticleisacasereport.

HuntPA,GreavesI,OwensWA.Emergencythoracotomyinthoracictrauma‐areview.Injury2006;37(1):1‐19.

Y Y Y Y N Exclusion.Reviewarticle.

KidherE,KrasopoulosG,CoatsT,CharitouA,MageeP,UppalR,etal.Theeffectofprehospitaltimerelatedvariablesonmortalityfollowingseverethoracictrauma.Injury2012;43(9):1386‐92.

Y N ? Y Y Exclusion.31prehospitalthoracotomies–samedataasAthanasiou2004,butfocus‐ingontimefactors.

LockeyD,CrewdsonK,DavisGTraumaticCardiacArrest:WhoAretheSurvi‐vors?AnnalsofEmergencyMedicine2006:48(3):240‐244

N Y Y N Y Exclusion.Wrongpopulation–survivorsonly.Outcomeofthegroupofinterestnotclear.SamepatientgroupasanalyzedinAthanasiou2004andDavis2011.

MorrisonJJ,MellorA,MidwinterM,MahoneyPF,ClasperJC.Ispre‐hospitalthoracotomynecessaryinthemilitaryenvironment?Injury2011;42(5):469‐73.

Y N Y Y Y Exclusion."Ourmainobjectivewastodetermineifanearly(pre‐hospital)thoracotomywouldhaveinfluencedtheoutcome"

PurkissSF,WilliamsM,CrossFW,GrahamTR,WoodA.Efficacyofurgentthoracotomyfortraumainpatientsattendedbyahelicopteremergencymedicalservice.JRCollSurgEdinb1994;39(5):289‐91.

Y Y Y Y N Exclusion.NinepatientshadanETperformedatthescene,onlytwoofthembecauseofcardiacarrest.

RabinoviciR,BugaevN.ResuscitativeThoracotomy:AnUpdate.ScandinavianJournalofSurgery:SJS2014;103(2):112‐9.

Y Y Y N N Exclusion.Reviewarticle.

RehnM,WeaverA,EshelbyS,LockeyD.London'sairambulance:3yearexperiencewithpre‐hospitaltransfusion.Resuscitation2015;96:156.

? Y Y N Y Exclusion.Conferenceab‐stract‐doesnotreportanyrelevantoutcomes.

22

Reference P I C O S Inclusion/exclusionSersarSI,AlanwarMA.Emergencythoracotomies:Twocenterstudy.J2013;6(1):11‐5.

Y N Y Y Y Exclusion.Patientsundergo‐inghospitalemergencythora‐cotomy.

ShapeyIM,KumarDS,RobertsK.Invasiveandsurgicalproceduresinpre‐hospi‐talcare:whatistheneed?EurJTraumaEmergSurg2012;38(6):633‐9.

Y Y Y Y N Exclusion.Threecasesofpre‐hospitalthoracotomy.

SuominenP,RasanenJ,KiviojaA.Efficacyofcardiopulmonaryresuscitationinpulselesspaediatrictraumapatients.Resuscitation1998;36(1):9‐13.

Y Y Y Y N Exclusion.Fivethoracotomiesperformed,onlyoneoftheminaprehospitalsetting.

Y,Yes;N,No;?,Unclear

P,Population;I,Intervention;C,Comparison;O,Outcome;S,StudyDesign

Norwegian Institute of Public HealthAugust 2017P.O. Box 4404 NydalenNO-0403 OsloPhone: +47 21 07 70 00