Clinical Appraisal of Needle Thoracostomy in a Canadian Aeromedical System
Date
2022-03
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Abstract
Background: Needle thoracostomy (NT) remains the standard for prehospital treatment of tension pneumothorax, but its effectiveness has been questioned in previous literature. The incidence of NT and clinical characteristics of patients receiving NT for tension pneumothorax in a Canadian helicopter emergency medical service (HEMS) setting have yet to be described. This lack of data leads to difficulty understanding who is at greatest risk for requiring NT, identifying factors that may be important to successful clinical outcomes, and implementing changes to practice. Methods: A retrospective chart review was conducted of adult patients who received NT from a Canadian HEMS service and a case study was conducted to document the novel use of an endotracheal tube to perform an improvised tube thoracostomy in response to NT failure. Results: Only a small proportion (1.3%) of patients attended by the HEMS service received NT during their care. The study sample was predominantly male (77.0%), with an average age of 46.4 years, and a presenting complaint of blunt trauma. Logistic regression analysis revealed initial NT treatment was associated with a low likelihood of clinical improvement in patients presenting with blunt trauma (OR = 0.18; p = .021), receiving CPR prior to NT (OR = 0.14; p = .02), or in those who received bilateral NT treatment (OR = 0.13; p < .01). A pre-treatment BP < 90 mmHg was the sole variable which was predictive of a positive clinical response to initial NT (OR = 3.33; p = .04). The case study provided a descriptive account of the successful use of a simple thoracostomy in combination with endotracheal tube insertion into the thorax to relieve tension pneumothorax following the failure of standard NT treatment in the HEMS setting. Conclusions: Of the patients studied, those most likely to receive NT were males who had suffered blunt trauma. NT may have questionable benefit for patients presenting with blunt trauma, cardiac arrest, or requiring bilateral NT. NT may be insufficient to adequately treat tension pneumothorax, and simple thoracostomy with thoracic endotracheal tube insertion has been successfully used to treat tension pneumothorax refractory to standard prehospital treatment.
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Keywords
adult, air ambulance, helicopter, Emergency Medical Services, pneumothorax, prehospital, retrospective studies, thoracostomy
Citation
Newton, G. (2022). Clinical appraisal of needle thoracostomy in a Canadian aeromedical system (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.