The efficacy of out-of-hospital needle and tube thoracostomy in major trauma victims

Abstract

Study objectives: Aeromedical crews routinely use needle thoracostomy (NT) and tube thoracostomy (TT) to treat major trauma victims with potential tension pneumothorax; however, the efficacy of out-of-hospital NT and TT is unknown. We explore the efficacy of aeromedical NT and TT in major trauma victims. Methods: A retrospective medical record review was performed using aeromedical records during a 5-year period. Aeromedical crews, which consist of a flight nurse and either a flight paramedic or emergency medicine resident, respond to scene calls from 2 bases and are requested at the discretion of first responders. Indications for NT and TT are at crews' discretion but include unstable vital signs and a mechanism consistent with potential tension pneumothorax. All major trauma victims undergoing placement of NT or TT by aeromedical personnel were included. Patients with incomplete data were excluded. Descriptive statistics were used to report the incidence of air release, clinical improvement (improved breath sounds or compliance if intubated, decreased dyspnea if nonintubated), and vital signs improvements (systolic blood pressure increase to ≥90 mm Hg or increase by 5 mm Hg if 100 beats/min; SaO 2 increase if Results: A total of 136 procedures (89 NT and 47 TT) in 81 patients were included. Response rates to NT (60% overall, 32% vital signs) and TT (75% overall, 60% vital signs) were high. Vital signs improvements were observed more often in patients with a pulse and in nonintubated patients. There was no relationship between responsiveness to NT and a subsequent response to TT. Conclusion: Aeromedical crews appear to correctly identify major trauma victims at risk for tension pneumothorax. We were unable to identify a subgroup of patients for whom either a response or the absence of a response to either NT or TT was predictable.