Needle thoracostomy

Aho, Johnathon M.; Thiels, Cornelius A.; Khatib, Moustafa M. El; Ubl, Daniel S.; Laan, Danuel V.; Berns, Kathleen S.; Habermann, Elizabeth B.; Zietlow, Scott P.; Zielinski, Martin D.

doi:10.1097/ta.0000000000000889

Cited by 36 publications

(7 citation statements)

References 22 publications

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“…Ultimately, a standardized approach to addressing tension pneumothorax in the prehospital setting should be implemented to reduce variability and improve outcomes. Recent advances in the type of catheter and anatomic position for PHND placement may improve success. The evolving role of prehospital point-of-care ultrasound may improve patient selection for PHND …”

Section: Discussionmentioning

confidence: 99%

Association of Prehospital Needle Decompression With Mortality Among Injured Patients Requiring Emergency Chest Decompression

et al. 2022

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ImportancePrehospital needle decompression (PHND) is a rare but potentially life-saving procedure. Prior studies on chest decompression in trauma patients have been small, limited to single institutions or emergency medical services (EMS) agencies, and lacked appropriate comparator groups, making the effectiveness of this intervention uncertain.ObjectiveTo determine the association of PHND with early mortality in patients requiring emergent chest decompression.Design, Setting, and ParticipantsThis was a retrospective cohort study conducted from January 1, 2000, to March 18, 2020, using the Pennsylvania Trauma Outcomes Study database. Patients older than 15 years who were transported from the scene of injury were included in the analysis. Data were analyzed between April 28, 2021, and September 18, 2021.ExposuresPatients without PHND but undergoing tube thoracostomy within 15 minutes of arrival at the trauma center were the comparison group that may have benefited from PHND.Main Outcomes and MeasuresMixed-effect logistic regression was used to determine the variability in PHND between patient and EMS agency factors, as well as the association between risk-adjusted 24-hour mortality and PHND, accounting for clustering by center and year. Propensity score matching, instrumental variable analysis using EMS agency-level PHND proportion, and several sensitivity analyses were performed to address potential bias.ResultsA total of 8469 patients were included in this study; 1337 patients (11%) had PHND (median [IQR] age, 37 [25-52] years; 1096 male patients [82.0%]), and 7132 patients (84.2%) had emergent tube thoracostomy (median [IQR] age, 32 [23-48] years; 6083 male patients [85.3%]). PHND rates were stable over the study period between 0.2% and 0.5%. Patient factors accounted for 43% of the variation in PHND rates, whereas EMS agency accounted for 57% of the variation. PHND was associated with a 25% decrease in odds of 24-hour mortality (odds ratio [OR], 0.75; 95% CI, 0.61-0.94; P = .01). Similar results were found in patients who survived their ED stay (OR, 0.68; 95% CI, 0.52-0.89; P &lt; .01), excluding severe traumatic brain injury (OR, 0.65; 95% CI, 0.45-0.95; P = .03), and restricted to patients with severe chest injury (OR, 0.72; 95% CI, 0.55-0.93; P = .01). PHND was also associated with lower odds of 24-hour mortality after propensity matching (OR, 0.79; 95% CI, 0.62-0.98; P = .04) when restricting matches to the same EMS agency (OR, 0.74; 95% CI, 0.56-0.99; P = .04) and in instrumental variable probit regression (coefficient, −0.60; 95% CI, –1.04 to –0.16; P &lt; .01).Conclusions and RelevanceIn this cohort study, PHND was associated with lower 24-hour mortality compared with emergent trauma center chest tube placement in trauma patients. Although performed rarely, PHND can be a life-saving intervention and should be reinforced in EMS education for appropriately selected trauma patients.

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Section: Discussionmentioning

confidence: 99%

Association of Prehospital Needle Decompression With Mortality Among Injured Patients Requiring Emergency Chest Decompression

et al. 2022

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“…The conventional NT procedure is the needle inserted along the superior margin of the second or third intercostal space at the midclavicular line 17,18 . However, in recent studies, needles as long as 8 cm have been required to perform this technique effectively [19][20][21] . Longer angiocatheters may increase the success rate of chest decompression but it may increase risks of unwanted damage.…”

Section: Discussionmentioning

confidence: 99%

A novel optical technology based on 690 nm and 850 nm wavelengths to assist needle thoracostomy

Lee

Chuang

et al. 2021

Sci Rep

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The sensitivity of pneumothorax diagnosis via handheld ultrasound is low, and there is no equipment suitable for use with life-threatening tension pneumothorax in a prehospital setting. This study proposes a novel technology involving optical fibers and near-infrared spectroscopy to assist in needle thoracostomy decompression. The proposed system via the optical fibers emitted dual wavelengths of 690 and 850 nm, allowing distinction among different layers of tissue in vivo. The fundamental principle is the modified Beer–Lambert law (MBLL) which is the basis of near-infrared tissue spectroscopy. Changes in optical density corresponding to different wavelengths (690 and 850 nm) and hemoglobin parameters (levels of Hb and HbO2) were examined. The Kruskal–Wallis H test was used to compare the differences in parameter estimates among tissue layers; all p-values were < 0.001 relevant to 690 nm and 850 nm. In comparisons of Hb and HbO2 levels relative to those observed in the vein and artery, all p-values were also < 0.001. This study proposes a new optical probe to assist needle thoracostomy in a swine model. Different types of tissue can be identified by changes in optical density and hemoglobin parameters. The aid of the proposed system may yield fewer complications and a higher success rate in needle thoracostomy procedures.

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“…18 Their findings were consistent with other researchers who reported failure rates of using a 5 cm angiocatheter to be as high as 94% and recommended using an 8 cm angiocatheter for NT. 11 19 ATLS recently updated their recommendations to include placement of a 5 cm to 8 cm angiocatheter in the fourth/ fifth ICS-MAL. 5 The Tactical Combat Casualty Care guidelines also recommended placement of a 3.25 inch (8.25 cm) angiocatheter in either the fifth ICS-MAL or the second ICS-MCL.…”

Section: Discussionmentioning

confidence: 99%

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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Needle thoracostomy

Cited by 36 publications

References 22 publications

Association of Prehospital Needle Decompression With Mortality Among Injured Patients Requiring Emergency Chest Decompression

Association of Prehospital Needle Decompression With Mortality Among Injured Patients Requiring Emergency Chest Decompression

A novel optical technology based on 690 nm and 850 nm wavelengths to assist needle thoracostomy

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

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