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Needle thoracostomy

Clinical effectiveness is improved using a longer angiocatheter

Aho, Johnathon M. MD; Thiels, Cornelius A. DO; El Khatib, Moustafa M. MBBCh; Ubl, Daniel S.; Laan, Danuel V. MD; Berns, Kathleen S. APRN; Habermann, Elizabeth B. PhD; Zietlow, Scott P. MD; Zielinski, Martin D. MD

Journal of Trauma and Acute Care Surgery: February 2016 - Volume 80 - Issue 2 - p 272–277
doi: 10.1097/TA.0000000000000889
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BACKGROUND Decompression of tension physiology may be lifesaving, but significant doubts remain regarding ideal needle thoracostomy (NT) catheter length in the treatment of tension physiology. We aimed to demonstrate increased clinical effectiveness of longer NT angiocatheter (8 cm) compared with current Advanced Trauma Life Support recommendations of 5-cm NT length.

METHODS This is a retrospective review of all adult trauma patients from 2003 to 2013 (age > 15 years) transported to a Level I trauma center. Patients underwent NT at the second intercostal space midclavicular line, either at the scene of injury, during transport (prehospital), or during initial hospital trauma resuscitation. Before March 2011, both prehospital and hospital trauma team NT equipment routinely had a 5-cm angiocatheter available. After March 2011, prehospital providers were provided an 8-cm angiocatheter. Effectiveness was defined as documented clinical improvement in respiratory, cardiovascular, or general clinical condition.

RESULTS There were 91 NTs performed on 70 patients (21 bilateral placements) either in the field (prehospital, n = 41) or as part of resuscitation in the hospital (hospital, n = 29). Effectiveness of NT was 48% until March 2011 (n = 24). NT effectiveness was significantly higher in the prehospital setting than in the hospital (68.3% success rate vs. 20.7%, p < 0.01). Patients who underwent NT using 8 cm compared with 5 cm were significantly more effective (83% vs. 41%, respectively, p = 0.01). No complications of NT were identified in either group.

CONCLUSION Eight-centimeter angiocatheters are more effective at chest decompression compared with currently recommended 5 cm at the second intercostal space midclavicular line.

LEVEL OF EVIDENCE Therapeutic study, level IV.

From the Department of Surgery (J.M.A., C.A.T., M.M.E.K., D.L.), Biomedical Engineering and Physiology (J.M.A.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (C.A.T., D.U., E.B.H.), Division of Trauma, Critical Care, and General Surgery (K.S.B., S.P.Z., M.Z.), Mayo Clinic, Rochester, Minnesota.

Submitted: June 1, 2015, Revised: July 30, 2015, Accepted: September 2, 2015.

Selected data from this work were presented in abstract form only as quality improvement projects at 2015 Mayo Clinic Quality Conference: Perspectives on Quality in the Care of Specific Patient Populations, March 16, 2015, Rochester, Minnesota, and the resident section of the American Medical Association Meeting, November 7, 2014, in Dallas Texas.

The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of NIH.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journalâ€(tm)s website (www.jtrauma.com).

Address for reprints: Martin D. Zielinski, MD, 200 First St SW, Rochester, MN 55905; email: zielinski.martin@mayo.edu.

© 2016 Lippincott Williams & Wilkins, Inc.