Prehospital Needle Decompression Improves Clinical Outcomes in Helicopter Evacuation Patients With Multisystem Trauma: A Multicenter Study

Henry, Reynold; Ghafil, Cameron; Golden, Adam; Matsushima, Kazuhide; Eckstein, Marc; Foran, Christopher; Theeuwen, Hailey; Bentley, David E; Inaba, Kenji; Strumwasser, Aaron

doi:10.55460/xdck-iy9j

Cited by 3 publications

(7 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Clinical improvement rates vary considerably between studies, ranging from 5.7% to 53% after PHND. 7,10,16,18,19 Several studies reported that improvements in dyspnea and hypoxia were more common than improvement in hemodynamic parameters, 7,10,18 although patients with hypotension have a 3-fold higher odds of having improvement in blood pressure than patients without hypotension before PHND. 16 We found comparable rates of physiologic improvement after PHND, with one-third of patients having at least 1 physiologic abnormality improving.…”

Section: Discussionmentioning

confidence: 99%

“…Prehospital needle decompression is rare; existing literature on the procedure consists of small, descriptive studies over short time periods . They typically include a single EMS agency or destination facility, thereby limiting generalizability . PHND is performed empirically based on clinical findings in the field.…”

Section: Introductionmentioning

confidence: 99%

“…8,9 They typically include a single EMS agency or destination facility, thereby limiting generalizability. [8][9][10] PHND is performed empirically based on clinical findings in the field. Tension pneumothorax cannot be confirmed after PHND is performed, making retrospective review challenging.…”

mentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Henry et al showed that the success rate of needle decompression performed for hypoxia (70.5%) was notably higher than that performed for hemodynamic instability (20.3%) [ 21 , 22 ]. The results suggest that needle decompression is more often successful at reversing respiratory indications, e.g., hypoxia for hemodynamic indications.…”

Section: Discussionmentioning

confidence: 99%

Endpoints in Vital Signs as a Useful Tool for Measuring Successful Needle Decompression After Traumatic Tension Pneumothorax: An Analysis of the National Emergency Medicine Information System Database

Okeke¹,

Hoag²,

Culhane³

2022

Cureus

View full text Add to dashboard Cite

BackgroundNeedle decompression is a useful tool in the pre-hospital setting for treating tension pneumothorax. However the specific improvements in vital signs that determine a successful decompression are only reported in a few studies and Emergency Medical Services (EMS) self-reported assessments of improvement are more commonplace. We hypothesize that EMS reports may exaggerate improvement when compared to objective vital sign changes. MethodologyThis is a retrospective cohort study using the National Emergency Medicine Information System (NEMSIS) for the year 2020. Vital signs recorded as objective endpoints include systolic blood pressure (SBP), pulse (HR), respiratory rate (RR), and oxygen saturation (SpO 2 ). Univariate analysis was performed using the t-test for continuous variables and the chi-square test for categorical variables. ResultsA total of 8,219 calls were included in the sample size analyzed. Most patients were white (2,911, 35.4%) and male (6,694, 81.4%). Abnormal vitals recorded as indications for needle decompression included SBP <100 mmHg, HR <60 or >100 beats/minute, RR <12 or >20 breaths/minute, and SpO 2 <93%. Statistically significant improvements were seen in the number of abnormal vital signs after the procedure. The percentage of improvement was higher in the EMS self-reported assessment than in objective findings for oxygen saturation and SBP. ConclusionsOur analysis shows objective improvement of hypoxia and hypotension after field needle decompression, supporting the efficacy of the procedure. The improvement based on vital sign change is modest and is less than that reported by EMS assessment of global improvement. This represents a target for quality improvement in EMS practice.

show abstract

“…Incorrect placement of NT can result in iatrogenic injury to underlying structures [ 1 , 2 ] and lead to grievous complications or death. Additionally, NT may fail due to poor technique, patient body habitus, and catheter length [ 3 – 6 ]. Our objective, therefore, was to explore novel means by which to improve the safety and efficacy of NT.…”

Section: Introductionmentioning

confidence: 99%

Prehospital portable ultrasound for safe and accurate prehospital needle thoracostomy: a pilot educational study

Dewar

Rogers³

et al. 2022

Ultrasound J

View full text Add to dashboard Cite

Background Simulated needle thoracostomy (NT) using ultrasound may reduce potential injury, increase accuracy, and be as rapid to perform as the traditional landmark technique following a brief educational session. Our objective was to determine if the use of an educational session demonstrating the use of handheld ultrasound to Emergency Medical Services (EMS) staff to facilitate NT was both feasible, and an effective way of increasing the safety and efficacy of this procedure for rural EMS providers. Methods A pre/post-educational intervention on a convenience sample of rural North American EMS paramedics and nurses. Measurement of location and estimated depth of placement of needle thoracostomy with traditional landmark technique was completed and then repeated using handheld ultrasound following a training session on thoracic ultrasound and correct placement of NT. Results A total of 30 EMS practitioners participated. Seven were female (23.3%). There was a higher frequency of dangerous structures underlying the chosen location with the landmark technique 9/60 (15%) compared to the ultrasound technique 1/60 (1.7%) (p = 0.08). Mean time-to-site-selection for the landmark technique was shorter than the ultrasound technique at 10.7 s (range 3.35–45 s) vs. 19.9 s (range 7.8–50 s), respectively (p < 0.001). There was a lower proportion of correct location selection for the landmark technique 40/60 (66.7%) when compared to the ultrasound technique 51/60 (85%) (p = 0.019). With ultrasound, there was less variance between the estimated and measured depth of the pleural space with a mean difference of 0.033 cm (range 0–0.5 cm) when ultrasound was used as compared to a mean difference of 1.0375 cm (range 0–6 cm) for the landmark technique (95% CI for the difference 0.73–1.27 cm; p < 0.001). Conclusions Teaching ultrasound NT was feasible in our cohort. While time-to-site-selection for ultrasound-guided NT took longer than the landmark technique, it increased safe and accurate simulated NT placement with fewer identified potential iatrogenic injuries.

show abstract

Prehospital Needle Decompression Improves Clinical Outcomes in Helicopter Evacuation Patients With Multisystem Trauma: A Multicenter Study

Cited by 3 publications

References 0 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

Endpoints in Vital Signs as a Useful Tool for Measuring Successful Needle Decompression After Traumatic Tension Pneumothorax: An Analysis of the National Emergency Medicine Information System Database

Prehospital portable ultrasound for safe and accurate prehospital needle thoracostomy: a pilot educational study

Contact Info

Product

Resources

About