Optimal anatomical location for needle chest decompression for tension pneumothorax: A multicenter prospective cohort study

Azizi, Nasim; Avest, Ewoud ter; Hoek, Amber E.; Pas, Y Admiraal-van de; Buizert, P J; Peijs, D R; Berg, Ingvar; Rosendaal, Arthur V; Boeije, Tom; Rietveld, V; Olgers, Tycho J; Maaten, J. C. ter

doi:10.1016/j.injury.2020.10.068

Cited by 8 publications

(8 citation statements)

References 16 publications

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“…Given the potential benefit paired with high variability of PHND seen in our study, we agree this provides a strong impetus to focus on refining the indications, identification, education, and technique in terms of type of catheter, anatomic position, and role finger thoracostomy to further improve the care of injured patients …”

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confidence: 67%

Prehospital Needle Decompression Should Not Be Compared With Trauma Center Chest Tube Placement—Reply

2023

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COMMENT & RESPONSEIn Reply We appreciate the interest of Jouffroy and Vivien in our study. 1 Given the reported failure rates and complications of prehospital needle decompression (PHND), the value of the intervention has been questioned. 2,3 Thus, we sought not to provide another detailed description in a case series but investigate in one of the largest populations undergoing PHND whether there is a potential outcome benefit to support further refinement and advancement of this technique. 1 A major limitation has been the difficulty of diagnosing tension pneumothorax in the field and the empirical nature of PHND, leading to a lack of comparative studies to establish effectiveness. While we acknowledge the assumptions in our comparison group of emergency tube thoracostomy raised here, we believe given the above difficulties, this is a group that potentially would have benefited from earlier chest decompression in the field given the current landscape of US prehospital medicine.We do agree that the lack of pulse oximetry is a limitation, but the Pennsylvania Trauma Outcome Study data set only added the admission data point in 2018 with nearly 75% missing values. As with any registry data set, the indications for most procedures including both PHND and tube thoracostomy are not recorded but require us to infer from available clinical information and diagnoses. We certainly agree that prehospital decompression in the right patient should be viewed as lifesaving and not wasted time; identifying critical lifesaving procedures is a top priority. The US emergency medical services system has several challenges, including heterogeneity in training, staffing, capabilities, and resources. Patients with tension pneumothorax from rural areas with longer transport times are most likely to benefit from PHND, but agencies in these areas are unfortunately the least likely to be able to afford and maintain an advanced prehospital ultrasonography program to aide in field identification.Given the potential benefit paired with high variability of PHND seen in our study, we agree this provides a strong impetus to focus on refining the indications, identification, education, and technique in terms of type of catheter, anatomic position, and role finger thoracostomy to further improve the care of injured patients. [4][5][6]

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confidence: 67%

Prehospital Needle Decompression Should Not Be Compared With Trauma Center Chest Tube Placement—Reply

2023

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“…The optimal location for NT continues to be debated in the literature [12,13]. Both the second ICS MCL and the fourth/fifth ICS in the anterior axillary line (ICS 4/5-AAL) have been proposed as the preferred locations.…”

Section: Discussionmentioning

confidence: 99%

Paramedic Understanding of Tension Pneumothorax and Needle Thoracostomy (NT) Site Selection

Lubin¹,

Knapp²,

Kettenmann³

2022

Cureus

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“…These latter findings bring into question the safety of using longer catheters at alternative sites. [8][9] We used needle decompression in the 2 nd intercostal space (ICS) midclavicular line (MCL) because it is traditional site for needle decompression and is easy to access and entails penetration of pectoral muscles and a variable quantity of subcutaneous tissue with or without oedema and subcutaneous emphysema 1 . Leigh smith study showed a standard 14 gauge (4.5 cm) cannula may not be long enough to penetrate parietal pleura with up to one third of trauma patients having a chest wall thickness greater than 5 cm in the 2nd ICS MCL.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately this site may have an increased risk of lung damage in the supine patient, as gas collects at the highest point and adhesions are most likely in more dependent parts of the lung. 8 Some studies showed the average chest wall thickness on the 2 nd ICS midclavicular line is 38 mm for men and 52 mm for women…”

Section: Discussionmentioning

confidence: 99%

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Failure of First Attempt Needle Decompression in Tension Pneumothorax: Case Report

Wisman¹,

Yaputra²

2022

AMCR

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Tension pneumothorax can occur as a potentially life threatening complication of chest trauma. Tension pneumothorax is commonly treated with needle decompression, both the 2nd intercostal space in the midclavicular line and the 4th/5th intercostal space in the anterior axillary. A 45 years old man came to our emergency department after blunt injury of the chest presenting tension pneumothorax with unstable hemodynamic treated with needle decompression using 14 gauge (4.5 cm) cannula at 2nd intercostal space mid clavicular line, patient successfully recover and became hemodynamic stable, after 30 minutes of successful needle decompression patient experienced with recurrent tension pneumothorax. Several studies show the failure of needle decompression it may due to several factor such as chest wall thickness, cannula length, and location of the needle decompression. In this case the cannula may has insufficient length (4.5 cm) to pass through the full thickness of the patient’s chest wall at 2nd intercostal space mid clavicular line (ICS 2) and makes air leaks from the lung faster than it can escape through the cannula.

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Optimal anatomical location for needle chest decompression for tension pneumothorax: A multicenter prospective cohort study

Cited by 8 publications

References 16 publications

Prehospital Needle Decompression Should Not Be Compared With Trauma Center Chest Tube Placement—Reply

Prehospital Needle Decompression Should Not Be Compared With Trauma Center Chest Tube Placement—Reply

Paramedic Understanding of Tension Pneumothorax and Needle Thoracostomy (NT) Site Selection

Failure of First Attempt Needle Decompression in Tension Pneumothorax: Case Report

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