370 The Relationship Between Adult Body Mass Index and Anticipated Failure Rate of Needle Decompression Using a 5 cm Needle for Tension Pneumothorax

Abstract

Tension pneumothorax is traumatic injury that can lead to rapid circulatory collapse and death. Emergent needle thoracostomy can quickly treat tension pneumothorax, but the best anatomic location and catheter length necessary to perform the intervention has been questioned in the recent years given the increasing rates of obesity in our population. We conducted a retrospective review of a convenience sample of all trauma patients admitted to our level 1 trauma center in Minneapolis, MN who underwent chest computed tomography (CT) during their admission between 2011 and 2012. Using these CT radiographs, chest wall thickness was measured bilaterally at the 2nd intercostal space (ICS) at the midclavicular line, and at the 4th and 5th intercostal spaces at the anterior axillary line. Baseline demographic data including age, sex, BMI, ISS and associated chest wall trauma were collected from medical chart review. Needle thoracostomy failure was defined as chest wall thickness (CWT) of > 5cm, based on the length of commonly used needle decompression needles. 141 patients who met all inclusion criteria were identified. There were no significant differences in mean CWT at any of the anatomic sites. CWT was similar between males and females. BMI > 30 was associated with an adjusted odds ratio of 13.8 (confidence interval 4.8-39.8) for failure with a standard 5cm catheter needle decompression. In the increasingly obese general population, needle thoracostomy with a standard 5cm needle may be more prone to failure. Adult BMI > 30 is a significant risk factor for anticipated failure of needle tube decompression. Alternative anatomic sites for needle decompression did not appear to increase the anticipated success of the intervention.