Needle Thoracostomy: Does Changing Needle Length and Location Change Patient Outcome?

Abstract

Changing the timing, length of needle, and location of placement did not change mortality in patients requiring NT. Needle thoracostomy was used more frequently after the change in policy, and the MAL cohort was less injured. No increase in reported complications was noted. WeichenthalLA, OwenS, StrohG, RamosJ. Needle thoracostomy: does changing needle length and location change patient outcome? Prehosp Disaster Med. 2018;33(3):237-244.

Prehospital Decompression of Pneumothorax: A Systematic Review of Recent Evidence

“…20 Three studies found a statistically significant mortality decrease when NCD was reported successful by the prehospital clinician. 19,28,29 The mortality was not associated with the needle length. 19,28 Using FT, the decompression success rate ranged between 9.7% to 32.0%.…”

“…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%.…”

“…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. One study reported three significant iatrogenic events, including one iatrogenic pneumothorax, one hematoma, and one vessel injury causing a hemothorax following NCD at 2ICS-MCL.…”