Abstract | March 11, 2024

A Retrospective Analysis of Needle Thoracostomies at a Level 2 Trauma Center

Sarthak Parikh DO, Orthopedic Surgery and Trauma Research Fellow, Saint Francis Health System, Tulsa, OK

Maryavis Howell MSN, TCRN, CEN, CPHRM, Director of Trauma Services, Saint Francis Health System Tulsa OK; Hung-Wen Yeh, Division of Health Services and Outcomes Research Children's Mercy Kansas City; Many Cheruvu, PhD, Manager, Clinical Research Clinical Research and Sponsored Programs Saint Francis Health System Tulsa OK; John Shellenberger MD Saint Francis Health System Tulsa OK.

Learning Objectives

  1. Prehospital needle decompressions should be performed in the 4th or 5th ICS MAL to avoid catheter dislodging
  2. According to the ITLS guidelines published in 2017, finger thoracostomy may be the best intervention for treatment of tension pneumothorax because it avoids many of the complications associated with catheter
  3. Improving education on proper diagnosis and management of tension pneumothorax can improve the efficacy rate of needle decompression and reduce negative outcomes

Introduction: A tension pneumothorax is a condition that results in an elevated pressure within the pleural space leading to lung compression, mediastinal shift, decreased venous return and ultimately cardiovascular collapse. The 2nd ICS MCL is the most commonly used decompression location; however some literature suggests that catheters placed in the 2nd ICS MCL are prone to have higher failure rates compared to the 5th ICS MAL (42.5% versus 16.7%, respectively).

Purpose: In this study, we aim to identify and scrutinize the prevalence of prehospital needle decompression from one tertiary care center over 8 years and examine their trends, efficacies, or pitfalls.

Methods: A set of 90 patient records obtained using the trauma registry, EPIC hyperspace and Oklahoma Emergency Medical Service Information System were included in the study. Data from these patients were retrospectively reviewed and analyzed to identify outcomes.

Results: Results showed a total of 117 needle thoracostomies were performed with 86 documented in the 2nd ICS MCL (63, 53.85%), 5th ICS AAL (7, 5.98%) and 5th ICS MAL (16, 13.68%).). The most documented indications for needle decompressions included diminished or absent breath sounds (52.70%), hypoxia (15.54%), hypotension and hemodynamic instability (6.76%). EMS reported improvements in 51 (56.67%) patients after needle thoracostomy. Improvements in vital signs after needle decompression were sporadic.

Conclusion: Needle decompressions should be performed after accurate diagnosis of tension pneumothorax in the 5th ICS, where research supports the lowest rate of complications and highest rate of success. Improvement of EMS education regarding thoracic trauma, early tension pneumothorax diagnosis and treatment can reduce complication rates and improve overall outcomes of needle decompressions in the prehospital setting.

References and Resources

  1. https://www.itrauma.org/wp-content/uploads/2017/12/Simple-Thoracostomy-for-Trauma-Arrest-FINAL-11-17.pdf. 
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