title: Needle thoracostomy: Clinical effectiveness is improved using a longer angiocatheter.
abstract: BACKGROUND
  Decompression of tension physiology may be lifesaving, but significant doubts remain regarding ideal needle thoracostomy (NT) catheter length in the treatment of tension physiology. We aimed to demonstrate increased clinical effectiveness of longer NT angiocatheter (8 cm) compared with current Advanced Trauma Life Support recommendations of 5-cm NT length.
  
  
  METHODS
  This is a retrospective review of all adult trauma patients from 2003 to 2013 (age > 15 years) transported to a Level I trauma center. Patients underwent NT at the second intercostal space midclavicular line, either at the scene of injury, during transport (prehospital), or during initial hospital trauma resuscitation. Before March 2011, both prehospital and hospital trauma team NT equipment routinely had a 5-cm angiocatheter available. After March 2011, prehospital providers were provided an 8-cm angiocatheter. Effectiveness was defined as documented clinical improvement in respiratory, cardiovascular, or general clinical condition.
  
  
  RESULTS
  There were 91 NTs performed on 70 patients (21 bilateral placements) either in the field (prehospital, n = 41) or as part of resuscitation in the hospital (hospital, n = 29). Effectiveness of NT was 48% until March 2011 (n = 24). NT effectiveness was significantly higher in the prehospital setting than in the hospital (68.3% success rate vs. 20.7%, p < 0.01). Patients who underwent NT using 8 cm compared with 5 cm were significantly more effective (83% vs. 41%, respectively, p = 0.01). No complications of NT were identified in either group.
  
  
  CONCLUSIONS
  Eight-centimeter angiocatheters are more effective at chest decompression compared with currently recommended 5 cm at the second intercostal space midclavicular line.
  
  
  METHODS
  Therapeutic study, level IV.
authors.affiliation: From the Department of Surgery (J.M.A., C.A.T., M.M.E.K., D.L.), Biomedical Engineering and Physiology (J.M.A.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (C.A.T., D.U., E.B.H.), Division of Trauma, Critical Care, and General Surgery (K.S.B., S.P.Z., M.Z.), Mayo Clinic, Rochester, Minnesota.
authors.forename: Johnathon M
authors.initials: JM
authors.lastname: Aho
authors.forename: Cornelius A
authors.initials: CA
authors.lastname: Thiels
authors.forename: Moustafa M
authors.initials: MM
authors.lastname: El Khatib
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Ubl
authors.forename: Danuel V
authors.initials: DV
authors.lastname: Laan
authors.forename: Kathleen S
authors.initials: KS
authors.lastname: Berns
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
authors.forename: Scott P
authors.initials: SP
authors.lastname: Zietlow
authors.forename: Martin D
authors.initials: MD
authors.lastname: Zielinski
mesh_terms: D000293:Adolescent; D000328:Adult; D019299:Decompression, Surgical / Q000295:instrumentation*; D004632:Emergency Medical Services; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D013907:Thoracostomy / Q000295:instrumentation*; D016896:Treatment Outcome; D062666:Vascular Access Devices; D014947:Wounds and Injuries / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D055815:Young Adult