title: Needle thoracostomy for tension pneumothorax: the Israeli Defense Forces experience.
abstract: BACKGROUND
  Point of injury needle thoracostomy (NT) for tension pneumothorax is potentially lifesaving. Recent data raised concerns regarding the efficacy of conventional NT devices. Owing to these considerations, the Israeli Defense Forces Medical Corps (IDF-MC) recently introduced a longer, wider, more durable catheter for the performance of rapid chest decompression. The present series represents the IDF-MC experience with chest decompression by NT.
  
  
  METHODS
  We reviewed the IDF trauma registry from January 1997 to October 2012 to identify all cases in which NT was attempted.
  
  
  RESULTS
  During the study period a total of 111 patients underwent chest decompression by NT. Most casualties (54%) were wounded as a result of gunshot wounds (GSW); motor vehicle accidents (MVAs) were the second leading cause (16%). Most (79%) NTs were performed at the point of injury, while the rest were performed during evacuation by ambulance or helicopter (13% and 4%, respectively). Decreased breath sounds on the affected side were one of the most frequent clinical indications for NT, recorded in 28% of cases. Decreased breath sounds were more common in surviving than in nonsurviving patients. (37% v. 19%, p < 0.001). A chest tube was installed on the field in 35 patients (32%), all after NT.
  
  
  CONCLUSIONS
  Standard NT has a high failure rate on the battlefield. Alternative measures for chest decompression, such as the Vygon catheter, appear to be a feasible alternative to conventional NT.
authors.affiliation: The IDF Medical Corps, the Department of Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel and the US Army Institute of Surgical Research, Fort Sam, Houston, Texas.
authors.forename: Jacob
authors.initials: J
authors.lastname: Chen
authors.affiliation: The IDF Medical Corps, Israel.
authors.forename: Roy
authors.initials: R
authors.lastname: Nadler
authors.affiliation: The IDF Medical Corps, the Department of Emergency Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: Dagan
authors.initials: D
authors.lastname: Schwartz
authors.affiliation: The Canadian Forces Health Services, the 1 Canadian Field Hospital, Petawawa, Ont., the Trauma Services and the Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont.
authors.forename: Homer
authors.initials: H
authors.lastname: Tien
authors.affiliation: The US Army Institute of Surgical Research, Fort Sam, Houston, Texas.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Cap
authors.affiliation: The IDF Medical Corps, the Trauma & Combat Medicine Branch, Surgeon General's HQ, Israel Defense Forces, Ramat Gan, Israel.
authors.forename: Elon
authors.initials: E
authors.lastname: Glassberg
mesh_terms: D000328:Adult; D019299:Decompression, Surgical / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008889:Military Personnel; D009339:Needles; D011030:Pneumothorax / Q000209:etiology / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000209:etiology / Q000601:surgery*; D013907:Thoracostomy / Q000295:instrumentation*; D016896:Treatment Outcome