The Safety andEfficacy of Prehospital Needle andTube Thoracostomy by Aeromedical Personnel

Abstract

Background.Aeromedical crews routinely use needle thoracostomy (NT) andtube thoracostomy (TT) to treat major trauma victims (MTVs) with potential tension pneumothorax; however, the efficacy of prehospital NT andTT is unclear.Objectives.To explore the efficacy of aeromedical NT andTT in MTVs.Methods.A retrospective chart review was performed using prehospital medical records andthe county trauma registry over a seven-year period. All MTVs 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), andvital signs improvements (systolic blood pressure [SBP] increase to ≥90 mm Hg or increase by 5 mm Hg if < 90 mm Hg; heart rate improvement to 60–100 beats/min, increase by 10 beats/min if < 60 BPM, or decrease by 10 beats/min if > 100 beats/min; oxygen saturation increase if < 95%) for both NT andTT as documented in prehospital medical records. Survival andimprovement in SBP based on trauma registry data were recorded for patients stratified by initial SBP.Results.A total of 136 procedures (89 NTs and47 TTs) in 81 patients were identified using prehospital medical records over a four-year period. Response rates to NT (60% overall, 32% vital signs) andTT (75% overall, 60% vital signs) were high. Vital signs improvements were observed more often in patients with a pulse andin nonintubated patients. A total of 168 patients were identified in the trauma registry over the seven-year study period. Normalization of SBP was observed in two-thirds of patients with a field SBP ≤ 90 mm Hg andone-third of patients in whom field SBP could not be obtained. A small but significant proportion of patients undergoing prehospital NT andTT, including some with prehospital hypotension andhigh injury severity, survived to hospital discharge. The incidence of complications was low.Conclusions.Aeromedical crews appear to appropriately select MTVs to undergo field NT or TT. A low incidence of complications anda small but significant group of unexpected survivors support continued use of this procedure by aeromedical personnel.Key words:aeromedical crews; trauma; needle thoracostomy; tube thoracostomy; survival; pneumothorax; efficacy.