The safety and efficacy of prehospital needle and tube thoracostomy by aeromedical personnel.
BACKGROUND
Aeromedical crews routinely use needle thoracostomy (NT) and tube thoracostomy (TT) to treat major trauma victims (MTVs) with potential tension pneumothorax; however, the efficacy of prehospital NT and TT is unclear.


OBJECTIVE
To explore the efficacy of aeromedical NT and TT in MTVs.


METHODS
A retrospective chart review was performed using prehospital medical records and the 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), and vital 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 and TT as documented in prehospital medical records. Survival and improvement in SBP based on trauma registry data were recorded for patients stratified by initial SBP.


RESULTS
A total of 136 procedures (89 NTs and 47 TTs) in 81 patients were identified using prehospital medical records over a four-year period. 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. 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 and one-third of patients in whom field SBP could not be obtained. A small but significant proportion of patients undergoing prehospital NT and TT, including some with prehospital hypotension and high 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 and a small but significant group of unexpected survivors support continued use of this procedure by aeromedical personnel.
Davis
Daniel P
DP
Department of Emergency Medicine, UCSD, San Diego, CA 92103, USA. davismd@cox.net
Pettit
Kelly
K
Rom
Christopher D
CD
Poste
Jennifer C
JC
Sise
Michael J
MJ
Hoyt
David B
DB
Vilke
Gary M
GM
D000337:Aerospace Medicine / Q000706:statistics & numerical data*; D002140:California; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011030:Pneumothorax / Q000209:etiology; D011674:Pulse; D012189:Retrospective Studies; D016019:Survival Analysis; D013907:Thoracostomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy