title: Modified Veress needle decompression of tension pneumothorax: a randomized crossover animal study.
abstract: BACKGROUND
  The current prehospital standard of care using a large bore intravenous catheter for tension pneumothorax (tPTX) decompression is associated with a high failure rate. We developed a modified Veress needle (mVN) for this condition. The purpose of this study was to evaluate the effectiveness and safety of the mVN as compared with a 14-gauge needle thoracostomy (NT) in a swine tPTX model.
  
  
  METHODS
  tPTX was created in 16 adult swine via thoracic CO2 insufflation to 15 mm Hg. After tension physiology was achieved, defined as a 50% reduction of cardiac output, the swine were randomized to undergo either mVN or NT decompression. Failure to restore 80% baseline systolic blood pressure within 5 minutes resulted in crossover to the alternate device. The success rate of each device, death, and need for crossover were analyzed using χ.
  
  
  RESULTS
  Forty-three tension events were created in 16 swine (24 mVN, 19 NT) at 15 mm Hg of intrathoracic pressure with a mean CO2 volume of 3.8 L. tPTX resulted in a 48% decline of systolic blood pressure from baseline and 73% decline of cardiac output, and 42% had equalization of central venous pressure with pulmonary capillary wedge pressure. All tension events randomized to mVN were successfully rescued within a mean (SD) of 70 (86) seconds. NT resulted in four successful decompressions (21%) within a mean (SD) of 157 (96) seconds. Four swine (21%) died within 5 minutes of NT decompression. The persistent tension events where the swine survived past 5 minutes (11 of 19 NTs) underwent crossover mVN decompression, yielding 100% rescue. Neither the mVN nor the NT was associated with inadvertent injuries to the viscera.
  
  
  CONCLUSIONS
  Thoracic insufflation produced a reliable and highly reproducible model of tPTX. The mVN is vastly superior to NT for effective and safe tPTX decompression and physiologic recovery. Further research should be invested in the mVN for device refinement and replacement of NT in the field.
authors.affiliation: From the Division of Trauma, Critical Care and Emergency Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Dafney
authors.initials: D
authors.lastname: Lubin
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Tang
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.forename: Matthew
authors.initials: M
authors.lastname: Martin
authors.forename: D J
authors.initials: DJ
authors.lastname: Green
authors.forename: Trevor
authors.initials: T
authors.lastname: Jones
authors.forename: Russell R
authors.initials: RR
authors.lastname: Means
authors.forename: Rashna
authors.initials: R
authors.lastname: Ginwalla
authors.forename: Terence S
authors.initials: TS
authors.lastname: O'Keeffe
authors.forename: Bellal A
authors.initials: BA
authors.lastname: Joseph
authors.forename: Julie L
authors.initials: JL
authors.lastname: Wynne
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Gary
authors.initials: G
authors.lastname: Vercruysse
authors.forename: Lynn
authors.initials: L
authors.lastname: Gries
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D000818:Animals; D002302:Cardiac Output; D018592:Cross-Over Studies; D019299:Decompression, Surgical / Q000295:instrumentation*; D004195:Disease Models, Animal; D004867:Equipment Design; D009339:Needles; D011030:Pneumothorax / Q000503:physiopathology / Q000601:surgery*; D011669:Pulmonary Wedge Pressure; D013552:Swine; D013907:Thoracostomy / Q000295:instrumentation; D016896:Treatment Outcome