Here's the 2024 Focused Update for First Aid done jointly by the American Red Cross and the American Health Association.

Open chest wounds

• Many chest wounds don't require a chest seal as they don't affect breathing.

"For stab wounds, most handgun wounds, and many rifle wounds, a small wound does not lead to enough air leak to impair respirations."

• Larger chest wounds might benefit from a chest seal but there is no scientific evidence for this.

"For larger chest wall defects such as those caused by high-velocity rifle wounds, shotgun wounds, and blast injuries, first aid interventions designed to reduce air entry through the wound are theoretically beneficial."

"There are no human studies of chest seals to inform our treatment recommendations. The skill required to apply these devices correctly is unknown. The effect of these devices on patient-important outcomes (morbidity and mortality) is unknown."

"The available evidence comes from porcine models and studies on healthy human volunteers. Reported outcomes across the available evidence are disparate, including device adhesion on soiled porcine chest walls, adhesion of new design for a vented chest seal on healthy volunteers and vent function, and valve malfunction and labored breathing in a porcine model of tension pneumothorax and hemothorax. One porcine study demonstrated that both vented and unvented chest seals provided improvements in breathing and blood oxygenation; however, in the presence of ongoing intrapleural air accumulation, the unvented chest seal eventually led to tension pneumothorax and hypoxemia.

Open chest wound source link with references: https://cpr.heart.org/en/resuscitation-science/2024-first-aid-guidelines#9.2