Simple thoracostomy in prehospital trauma management is safe and effective: a 2-year experience by helicopter emergency medical crews.
OBJECTIVE
To evaluate the effectiveness and potential complications of simple thoracostomy, as first described by Deakin, as a method for prehospital treatment of traumatic pneumothorax.


METHODS
Prospective observational study of all severe trauma patients rescued by our Regional Helicopter Emergency Medical Service and treated with on-scene simple thoracostomy, over a period of 25 months, from June 1, 2002 to June 30, 2004.


RESULTS
Fifty-five consecutive severely injured patients with suspected pneumothorax and an average Revised Trauma Score of 9.6+/-2.7 underwent field simple thoracostomy. Oxygen saturation significantly improved after the procedure (from 86.4+/-10.2% to 98.5%+/-4.7%, P<0.05). No difference exists in the severity of thoracic lesions between patients with systolic arterial pressure and oxygen saturation below and above or equal to 90. A pneumothorax or a haemopneumothorax was found in 91.5% of the cases and a haemothorax in 5.1%. No cases of major bleeding, lung laceration or pleural infection were recorded. No cases of recurrent tension pneumothorax were observed. Forty (72.7%) patients survived to hospital discharge.


CONCLUSIONS
Prehospital treatment of traumatic pneumothorax by simple thoracostomy without chest tube insertion is a safe and effective technique.
Massarutti
Daniele
D
Helicopter Emergency Medical Service Friuli-Venezia Giulia, Udine Hospital, Udine, Italy. massarutti.daniele@aoud.sanita.fvg.it
Trillò
Giulio
G
Berlot
Giorgio
G
Tomasini
Ariella
A
Bacer
Barbara
B
D'Orlando
Loris
L
Viviani
Marino
M
Rinaldi
Adriano
A
Babuin
Alberto
A
Burato
Lorenzo
L
Carchietti
Elio
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000401:Aircraft; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006468:Hemopneumothorax / Q000601:surgery; D006491:Hemothorax / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000601:surgery*; D011446:Prospective Studies; D013898:Thoracic Injuries / Q000601:surgery*; D013907:Thoracostomy / Q000009:adverse effects*; D014949:Wounds, Nonpenetrating / Q000601:surgery*