Simple thoracostomy in prehospital trauma management is safe and effective: a 2-year experience by helicopter emergency medical crews

Marrelli, Daniele; Trillò, Giulio; Berlot, Giorgio; Tomasini, Ariella; Bacer, Barbara; D'Orlando, Loris; Viviani, Marino; Rinaldi, Adriano; Babuin, Alberto; Burato, Lorenzo; Carchietti, Elio

doi:10.1097/00063110-200610000-00006

Cited by 76 publications

(37 citation statements)

References 18 publications

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“…16,17 Thoracostomy is therefore recommended over needle decompression. [18][19][20] Thoracostomy is achieved by making a skin incision followed by blunt dissection with forceps or finger through the intercostal muscles and pleura in the same location that an intercostal drain is usually placed (fourth or fifth intercostal space, in the mid-axillary line). The tension pneumothorax is relieved as the pleura is breeched.…”

Section: Management Of Reversible Causesmentioning

confidence: 99%

Traumatic cardiac arrest

2015

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Traumatic cardiac arrest is known to have a poor outcome, and some authors have stated that attempted resuscitation from traumatic cardiac arrest is futile. However, advances in damage control resuscitation and understanding of the differences in pathophysiology of traumatic cardiac arrest compared to medical cardiac arrest have led to unexpected survivors. Recently published data have suggested that outcome from traumatic cardiac arrest is no worse than that for medical causes of cardiac arrest, and in some groups may be better. This review highlights key areas of difference between traumatic cardiac arrest and medical cardiac arrest, and outlines a strategy for the management of patients in traumatic cardiac arrest. Standard Advanced Life Support algorithms should not be used for patients in traumatic cardiac arrest.

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Section: Management Of Reversible Causesmentioning

confidence: 99%

Traumatic cardiac arrest

2015

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“…The next mention in the literature of this procedure is 10 years later with a prospective cohort study of 55 consecutive severely injured patients with suspected pneumothorax who were treated by an Italian helicopter emergency medical service. 3 This study further demonstrated the relative safety and efficacy of the procedure with significant improvement in oxygen saturation and no cases of major bleeding, lung laceration, or pleural infection. Although not published as a case series, a letter to the editor regarding this study made reference to some 1079 thoracostomies that had been performed over a 10-year period at London HEMS.…”

Section: Discussionmentioning

confidence: 55%

Four years of pre-hospital simple thoracostomy performed by a physician-paramedic helicopter emergency medical service team: A description and review of practice

Chesters

Davies

Wilson

2015

Trauma

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Background: Essex and Herts Air Ambulance Trust operate doctor-paramedic pre-hospital care teams. Simple thoracostomy is performed if an intubated patient requires pleural decompression. Reports of the use of this technique are uncommon in the literature. This study describes the use of pre-hospital thoracostomy over four years. Pre-hospital complications and effect on oxygen saturations were also noted. Methods: A retrospective database review of all missions that occurred between 1 April 2010 and 31 March 2014. All patients undergoing this procedure were included. Results: A total of 126 patients were identified. In 110 (87%) of the total number of patients, the procedure was bilateral making the total number of thoracostomies performed 236. The mechanism of injury was blunt trauma in 115 (91%) and penetrating trauma in 11 patients (9%). The primary indication was traumatic cardiac arrest or peri-arrest in 51 patients (40%), high risk of pneumothorax in a ventilated patient in 45 patients (36%), pneumothorax diagnosed prior to delivery of anaesthesia in 17 patients (13%), and unexplained hypoxia in a ventilated patient in 13 patients (10%). The mean pulse oximetry measurement at the time of arrival was 91.8% and 97.2% at the time of handover (p¼0.003). No immediate complications were recorded on the database. Conclusion: We have described the regular use of the technique of simple thoracostomy in trauma patients attended by our air ambulance service. It is the largest case series to date of simple thoracostomy being used in the context of prehospital chest trauma.

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“…1). Elle est donc beaucoup plus rapide à utiliser pour décomprimer une plèvre et présente peu de risque [7,8]. Le matériel indispensable à sa réalisation comprend : un scalpel à lame fine, une pince de Kocher et de quoi faire un pansement (ou une valve d'Asherman).…”

Section: Incidence Des éPanchements Pleuraux Compressifsunclassified

“…Cette proposition repose sur un travail récent qui a montré que l'insertion d'un drain thoracique en cas d'arrêt cardiaque post-traumatique augmentait la probabilité de reprise d'activité cardiaque et de survie à 24 heures [10]. On peut ainsi considérer que le rapport bénéfice/risque est en faveur de la réalisation de la thoracostomie bilatérale [8]. L'orifice de thoracostomie est ensuite recouvert par un pansement simple, non occlusif, avec une fermeture sur trois côtés, ou appareillé avec une valve d'Asherman.…”

Section: Incidence Des éPanchements Pleuraux Compressifsunclassified

Thoracostomie en urgence

David

Demaret

Gueugniaud

2011

Ann. Fr. Med. Urgence

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Dans les suites d'un traumatisme sévère, un épan-chement pleural compressif peut être responsable d'un arrêt cardiaque ou d'une détresse vitale, respiratoire ou circulatoire. Il importe alors au praticien de pouvoir rapidement décomprimer la plèvre du patient. Cette décompression sera au mieux réalisée par une thoracostomie, en particulier lors d'un arrêt cardiaque ou d'un échec de décompression à l'aiguille. La thoracostomie est faite sur le quatrième ou cinquième espace intercostal, au niveau de la ligne axillaire antérieure. Après incision cutanée, les muscles intercostaux sont franchis à l'aide d'une pince de Kocher, afin de réaliser un toucher pulmonaire au doigtz. Pour citer cette revue : Ann. Fr. Med. Urgence 1 (2011). Mots clés Thoracostomie · Traumatisme thoracique · Arrêt cardiaque · PneumothoraxAbstract A tension pneumothorax or a pleural effusion causing mediastinal shift may result from severe trauma and may produce a cardiac arrest or life-threatening respiratory or circulatory disturbance. It is then incumbent on the doctor to be able to decompress the pleural space rapidly. The best way to effect this decompression is by thoracostomy, especially in a cardiac arrest situation or where needle decompression has not been successful. Thoracostomy is performed in the fourth or fifth intercostal space in the anterior axillary line. After making a cutaneous incision, the intercostal muscles are opened with a Kocher forceps, followed by the insertion of a finger into the pleural space.

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Simple thoracostomy in prehospital trauma management is safe and effective: a 2-year experience by helicopter emergency medical crews

Abstract: Prehospital treatment of traumatic pneumothorax by simple thoracostomy without chest tube insertion is a safe and effective technique.

Cited by 76 publications

References 18 publications

Traumatic cardiac arrest

Traumatic cardiac arrest

Four years of pre-hospital simple thoracostomy performed by a physician-paramedic helicopter emergency medical service team: A description and review of practice

Thoracostomie en urgence

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