title: Standard laparoscopic trocars for the treatment of tension pneumothorax: a superior alternative to needle decompression.
abstract: BACKGROUND
  Needle thoracostomy (NT) is a commonly taught intervention for tension pneumothorax (tPTX) but has a high failure rate. We hypothesize that standard 5-mm laparoscopic trocars may be a safe and more effective alternative.
  
  
  METHODS
  Thirty episodes of tPTX and 27 episodes of tension-induced pulseless electrical activity (PEA) were induced in five adult swine using thoracic CO2 insufflation via balloon trocar. Tension was defined as a 50% decrease in cardiac output. Chest decompression was performed with 5-mm laparoscopic trocars for the treatment of both tPTX with hemodynamic compromise and tension-induced PEA. The lungs and heart were inspected and graded at necropsy for trocar-related injury. Results were also compared with success rates with NT in the same model.
  
  
  RESULTS
  The placement of a 5-mm trocar rapidly and immediately relieved tension physiology in 100% of the cases. Mean arterial pressure, cardiac output, central venous pressure, and pulmonary capillary wedge pressure all returned to baseline within 1 minute of trocar placement. Adequate perfusion was restored in 100% of tension-induced PEA cases within 30 seconds of trocar placement. There was no evidence of trocar-related heart or lung damage in any of the experimental animals at necropsy (mean injury scores, 0 for both). Five-millimeter trocars significantly outperformed standard NT for both tPTX and tension-induced PEA arrest.
  
  
  CONCLUSIONS
  tPTX and tension-induced PEA can be safely and effectively treated with chest decompression using 5-mm laparoscopic trocars. This technique may serve as a more rapid and reliable alternative to needle decompression.
authors: From the Department of Surgery (Q.H., M.D., E.J., M.M.), Madigan Army Medical Center, Tacoma, Washington; Department of Surgery (M.M.), Legacy Emanuel Medical Center, Portland, Oregon, and Department of Surgery (K.I.), LA County Hospital + USC Medical Center, Los Angeles, California.
authors: Quinton
authors: Q
authors: Hatch
authors: Mia
authors: M
authors: Debarros
authors: Eric
authors: E
authors: Johnson
authors: Kenji
authors: K
authors: Inaba
authors: Matthew
authors: M
authors: Martin
mesh_terms: D000818:Animals; D002302:Cardiac Output; D019299:Decompression, Surgical; D004867:Equipment Design; D010535:Laparoscopy / Q000295:instrumentation*; D011030:Pneumothorax / Q000503:physiopathology / Q000601:surgery*; D013552:Swine; D013907:Thoracostomy