Needle thoracostomy for tension pneumothorax: failure predicted by chest computed tomography.
OBJECTIVE
Tension pneumothorax can lead to cardiovascular collapse and death. In the prehospital setting, needle thoracostomy for emergent decompression may be lifesaving. Taught throughout the United States to emergency medical technicians (EMTs) and physicians, the true efficacy of this procedure is unknown. Some question the utility of this procedure in the prehospital setting, doubting that the needle actually enters the pleural space. This study was designed to determine if needle decompression of a suspected tension pneumothorax would access the pleural cavity as predicted by chest computed tomography (CT).


METHODS
We retrospectively reviewed consecutive adult trauma patients admitted to a level I trauma center between January and March 2005. We measured chest wall depth at the second intercostal space, midclavicular line on CT scans. Data on chest wall thickness were compared with the standard 4.4-cm angiocatheter used for needle decompression.


RESULTS
Data from 110 patients were analyzed. The mean age of the patients was 43.5 years. The mean chest wall depth on the right was 4.5 cm (+/- 1.5 cm) and on the left was 4.1 cm (+/- 1.4 cm). Fifty-five of 110 patients had at least one side of the chest wall measuring greater than 4.4 cm.


CONCLUSIONS
The standard 4.4-cm angiocatheter is likely to be unsuccessful in 50% (95% confidence interval = 40.7-59.3%) of trauma patients on the basis of body habitus. In light of its low predicted success, the standard method for treatment of tension pneumothorax by prehospital personnel deserves further consideration.
Stevens
Robert L
RL
F. H. Sammy Ross Jr. Trauma Center, Charlotte, North Carolina, USA.
Rochester
Angel A
AA
Busko
Jonathan
J
Blackwell
Thomas
T
Schwartz
Daniel
D
Argenta
Anne
A
Sing
Ronald F
RF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004635:Emergency Medicine / Q000193:education; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000601:surgery*; D035441:Thoracic Wall / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D013907:Thoracostomy / Q000009:adverse effects* / Q000379:methods* / Q000592:standards; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D055815:Young Adult