Simple Thoracostomy Avoids Chest Drain Insertion in Prehospital Trauma

Abstract

Tension pneumothorax and hemothorax are life-threatening emergencies that require immediate treatment. Field stabilization of trauma patients often requires rapid surgical drainage of these injuries but inevitably delays departure for hospital. Conventional treatment involves the insertion of a chest drain but we describe a modified technique of simple thoracostomy that is faster and simpler to perform and avoids the risks associated with insertion of the chest drain. Following use of a simple thoracostomy as an alternative to chest drain insertion in 45 patients at the roadside, this technique appears to have important advantages over conventional techniques and warrants further clinical evaluation.

Traumatic cardiac arrest

“…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.…”

“…In patients undergoing positive pressure ventilation, the underlying lung usually inflates and so the insertion of the intercostal drain (through the same hole) can be deferred. 19 In one series of 37 cases of pre-hospital traumatic cardiac arrest, 18 patients underwent chest decompression, resulting in return of spontaneous circulation (ROSC) in four patients with presumed tension pneumothorax. 18 In a larger series of 909 patients, six had ROSC following decompression of a tension pneumothorax.…”

Pre-Hospital and In-Hospital Thoracostomy: Indications and Complications

“…[3][4][5][6] Classical management of tension pneumothorax in the pre-hospital arena is needle decompression, 7 but this is an inexact technique that may be ineffective and potentially dangerous. [8][9][10][11] Some advanced emergency medical services use a formal thoracostomy, with 11,12 or without 13 chest tube insertion. While this procedure has been reported as safe 11,12 and more effective than needle decompression, 14 its associated morbidity is not well described.…”

Crush injury by an elephant: life‐saving prehospital care resulting in a good recovery

“…1,7 Definition: open surgical procedure to create a connection between the pleural space and the atmosphere without insertion of a chest tube. This technique can only be used for patients undergoing positive pressure ventilation.…”