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Background: Tension pneumothorax requires emergent decompression. Unfortunately, some needle thoracostomies (NTs) are unsuccessful because of insufficient catheter length. All previous studies have used thickness of the chest wall (based on cadaver studies, ultrasonography or computed tomography [CT]) to extrapolate probable catheter effectiveness. The objective of this clinical study was to identify the frequency of NT failure with various catheter lengths.
Methods:We evaluated the records of all patients with severe blunt injury who had a prehospital NT before arrival at a level-1 trauma centre over a 48-month period. Patients were divided into 2 groups: helicopter (4.5-cm catheter sheath) and ground ambulance (3.2 cm) transport. Success of the NT was confirmed by the absence of a large pneumothorax on subsequent thoracic ultrasonography and CT.
Results: Needle thoracostomy decompression was attempted in 1.5% (142/9689) of patients. Among patients with blunt injuries, the incidence was 1.4% (101/7073). Patients transported by helicopter (74%) received a 4.5-cm sheath. The remainder (26% ground transport) received a 3.2-cm catheter. A minority in each group (helicopter 15%, ground 28%) underwent immediate chest tube insertion (before thoracic ultrasound) because of ongoing hemodynamic instability. Failure to decompress the pleural space by NT was observed via ultrasound and/or CT in 65% (17/26) of attempts with a 3.2-cm catheter, compared with only 4% (3/75) of attempts with a 4.5-cm catheter (p < 0.001).
Conclusion: Tension pneumothorax decompression using a 3.2-cm catheter was unsuccessful in up to 65% of cases. When a larger 4.5-cm catheter was used, fewer procedures (4%) failed. Thoracic ultrasonography can be used to confirm NT placement.
Contexte : Le pneumothorax compressif requiert une décompression urgente. Malheureusement, certaines thoracotomies à l'aiguille échouent parce que les cathéters ne sont suffisamment longs. Toutes les études antérieures se sont basées sur l'épaisseur de la paroi thoracique (obtenue par examen de cadavres, échographie ou tomographie assistée par ordinateur) pour extrapoler l'efficacité probable des cathéters. L'objectif de la présente étude clinique était de mesurer la fréquence de l'échec des thoracotomies à l'aiguille selon la longueur des cathéters utilisés.
Méthodes : Nous avons examiné les dossiers de tous les patients victimes d'un grave traumatisme fermé et soumis à une thoracotomie à l'aiguille avant leur arrivée dans un centre de traumatologie de premier niveau sur une période de 48 mois. Les...