Relative device stability of anterior versus axillary needle decompression for tension pneumothorax during casualty movement

Leatherman, Matthew; Held, Jenny M.; Fluke, Laura M.; McEvoy, Christian S.; Inaba, Kenji; Grabo, Daniel; Martin, Matthew J.; Earley, Angela S.; Ricca, Robert L.; Polk, Travis M.

doi:10.1097/ta.0000000000001488

Cited by 10 publications

(6 citation statements)

References 27 publications

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“…Aside from elasticity, catheters can also be dislodged during transport. 9 This likely means that some of the catheters we identified as outside the pleural space were, at one point during transport, properly placed, and our result of 76 per cent may overestimate the failure rate. The 39 per cent of our patients who had no pneumothorax at all likely underestimates the true failure rate because many patients had a TT placed before CT scans because of a concerning clinical condition and a report of a prehospital ND.…”

Section: Limitationsmentioning

confidence: 82%

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Failure Rate of Prehospital Needle Decompression for Tension Pneumothorax in Trauma Patients

Lesperance

Carroll

Aden

et al. 2018

The American Surgeon™

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Tension pneumothorax is commonly treated with needle decompression (ND) at the 2nd intercostal space midclavicular line (2nd ICS MCL) but is thought to have a high failure rate. Few studies have attempted to directly measure the failure rate in patients receiving the intervention. We performed a retrospective analysis of 10 years of patients receiving prehospital ND. CT scans were reviewed to record the location of catheters left indwelling and the proportion of patients who did not have any pneumothorax. Chest wall thickness was measured on both injured and uninjured sides at the 2nd ICS MCL and compared with the recommended alternative, the 5th ICS anterior axillary line (5th ICS AAL). We identified 335 patients that underwent prehospital ND who had CT scans performed. Using our two different radiologic methods of assessing failure, 39 per cent and 76 per cent of attempts at ND failed to reach the pleural space. In addition, at least 39 per cent of patients did not have a tension pneumothorax. Injured chest walls were significantly thicker than uninjured chest walls at both the 2nd ICS MCL and the 5th ICS AAL (both P < 0.005.) Increasing chest wall thickness correlated with the failure of the catheter to reach the pleural space. Using an 8-cm catheter at the 5th ICS AAL, iatrogenic cardiac injury was at risk in 42 per cent of patients. This series confirms the high failure rate of ND at the 2nd ICS MCL, but further studies are needed to assure the safety of using larger catheters at the 5th ICS AAL.

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Section: Limitationsmentioning

confidence: 82%

“…16 Not only does ND at the 2nd ICS MCL seem to have a significant failure rate, identification of the 2nd ICS MCL is difficult, 17 and associated with serious complications. [18][19][20][21] Catheter placement at the 5th ICS AAL seems to be more stable 9 and easier to teach. 3…”

Section: Discussionmentioning

confidence: 99%

Failure Rate of Prehospital Needle Decompression for Tension Pneumothorax in Trauma Patients

Lesperance

Carroll

Aden

et al. 2018

The American Surgeon™

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“…However, this was a cadaveric study involving a select BMI of 24 kg/m 2 , which does not represent our patient population. 17 In addition to identifying the proper location, an appropriate needle length is also crucial for a successful catheter placement. Givens and colleagues 18 challenged the previous recommendations of a 5 cm angiocatheter.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, they concluded that the fourth/fifth ICS-AAL may be a better option in patients with a suspected thicker chest wall or in patients in which a prior NT attempt had failed. 16 Furthermore, Leatherman and colleagues 17 noted that the fifth ICS-AAL was most stable for combat casualty transport. However, this was a cadaveric study involving a select BMI of 24 kg/m 2 , which does not represent our patient population.…”

Section: Discussionmentioning

confidence: 99%

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Emergent needle thoracostomy in prehospital trauma patients: a review of procedural execution through computed tomography scans

Neeki

Cheung

Dong

et al. 2021

Trauma Surg Acute Care Open

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BackgroundTraumatic tension pneumothoraces (TPT) are among the most serious causes of death in traumatic injuries, requiring immediate treatment with a needle thoracostomy (NT). Improperly placed NT insertion into the pleural cavity may fail to treat a life-threatening TPT. This study aimed to assess the accuracy of prehospital NT placements by paramedics in adult trauma patients.MethodsA retrospective chart review was performed on 84 consecutive trauma patients who had received NT by prehospital personnel. The primary outcome was the accuracy of NT placement by prehospital personnel. Comparisons of various variables were conducted between those who survived and those who died, and proper versus improper needle insertion separately.ResultsProper NT placement into the pleural cavity was noted in 27.4% of adult trauma patients. In addition, more than 19% of the procedures performed by the prehospital providers appeared to have not been medically indicated.DiscussionLong-term strategies may be needed to improve the capabilities and performance of prehospital providers’ capabilities in this delicate life-saving procedure.Level of evidenceIV.

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Advanced Trauma Life Support

Parrino,

Fransman,

Varone

et al. 2024

Recent Strategies in High Risk Surgery

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Relative device stability of anterior versus axillary needle decompression for tension pneumothorax during casualty movement

Abstract: Therapeutic study, level III.

Cited by 10 publications

References 27 publications

Failure Rate of Prehospital Needle Decompression for Tension Pneumothorax in Trauma Patients

Failure Rate of Prehospital Needle Decompression for Tension Pneumothorax in Trauma Patients

Emergent needle thoracostomy in prehospital trauma patients: a review of procedural execution through computed tomography scans

Advanced Trauma Life Support

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