Finger thoracostomy in patients with chest trauma performed by paramedics on a helicopter emergency medical service

Abstract

ObjectiveTo determine the frequency of finger thoracostomy performed by intensive care flight paramedics after the introduction of a training programme in this procedure and complications of the procedure that were diagnosed after hospital arrival.MethodsThis was a retrospective cohort study of adult and paediatric trauma patients undergoing finger thoracostomy performed by paramedics on a helicopter emergency medical service between June 2015 and May 2018. Hospital data were obtained through a manual search of the medical records at each of the three receiving major trauma services. Additional data were sourced from the Victorian State Trauma Registry.ResultsThe final analysis included 103 cases, of which 73.8% underwent bilateral procedures with a total of 179 finger thoracostomies performed. The mean age of patients was 42.8 (standard deviation 21.4) years and 73.8% were male. Motor vehicle collision was the most common mechanism of injury accounting for 54.4% of cases. The median Injury Severity Score was 41 (interquartile range 29–54). There were 30 patients who died pre‐hospital, with most (n = 25) having finger thoracostomy performed in the setting of a traumatic cardiac arrest. A supine chest X‐ray was performed prior to intercostal catheter insertion in 38 of 73 patients arriving at hospital; of these, none demonstrated a tension pneumothorax. There were three cases of potential complications related to the finger thoracostomy.ConclusionFinger thoracostomy was frequently performed by intensive care flight paramedics. It was associated with a low rate of major complications and given the deficiencies of needle thoracostomy, should be the preferred approach for chest decompression.

Prehospital Decompression of Pneumothorax: A Systematic Review of Recent Evidence

“…A total of 1,420 unique citations were obtained by the literature search strategy, of which 20 original studies (two prospective cohort or case series and 18 retrospective cohort or cases series) fulfilled the inclusion criteria. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] Each study included between 24 and 2,574 patients and most studies (n = 9) were conducted in the United States of America. The main mechanism was blunt trauma.…”

“…The main mechanism was blunt trauma. Twelve studies presented data on efficacy, patient outcomes, and/or adverse events, [19][20][21][22][23][24][25][26][27][28][29]36 while ten studies presented findings limited to anatomical measures and predicted success rate and outcomes (two studies presented results relevant to both categories). 19,[30][31][32][33][34][35][36][37][38] Characteristics of the included studies are presented in Table 1 and Table 2. Robitaille-Fortin, Norman, Archer, et al…”

“…The most clinically studied chest decompression technique was NCD (n = 7), [19][20][21]23,26,28,29 followed by FT (n = 5) [22][23][24][25]27 and CTP (n = 3). 21,25,26 Overall, the success rate of NCD ranged between 18% and 86%.…”

“…19,28 Using FT, the decompression success rate ranged between 9.7% to 32.0%. [22][23][24][25]27 In a case series of 250 patients following FT or CTP, the reported improvement rate was 30%. 25 One study found an improved oxygen saturation at hospital arrival compared to the on-field oxygen saturation prior to FT (P = .003).…”

“…20,22 In a case series of six patients, CTP was reported successful during 83% of prehospital interventions for patients with a tension pneumothorax. 26 Four studies reported a return of spontaneous circulation (ROSC) rate between 15.7% and 25.0% with associated survival from 0.6% to 9.4% for traumatic cardiac arrest following prehospital FT. [23][24][25]27 A single study reporting on six patients following the prehospital use of a 10 French Vygon thoracic trocar and drain catheter did not present data on patient outcomes. 21 Most studies (n = 6) 19,21,22,[27][28][29] did not report any adverse events or complications relative to chest decompression.…”