title: Failure rate of prehospital chest decompression after severe thoracic trauma.
abstract: BACKGROUND
  Chest decompression can be performed by different techniques, like needle thoracocentesis (NT), lateral thoracostomy (LT), or tube thoracostomy (TT). The aim of this study was to report the incidence of prehospital chest decompression and to analyse the effectiveness of these techniques.
  
  
  METHODS
  In this retrospective case series study, all medical records of adult trauma patients undergoing prehospital chest decompression and admitted to the resuscitation area of a level-1 trauma center between 2009 and 2015 were reviewed and analysed. Only descriptive statistics were applied.
  
  
  RESULTS
  In a 6-year period 24 of 2261 (1.1%) trauma patients had prehospital chest decompression. Seventeen patients had NT, six patients TT, one patient NT as well as TT, and no patients had LT. Prehospital successful release of a tension pneumothorax was reported by the paramedics in 83% (5/6) with TT, whereas NT was effective in 18% only (3/17). In five CT scans all thoracocentesis needles were either removed or extrapleural, one patient had a tension pneumothorax, and two patients had no pneumothorax. No NT or TT related complications were reported during hospitalization.
  
  
  CONCLUSIONS
  Prehospital NT or TT is infrequently attempted in trauma patients. Especially NT is associated with a high failure rate of more than 80%, potentially due to an inadequate ratio between chest wall thickness and catheter length as previously published as well as a possible different pathophysiological cause of respiratory distress. Therefore, TT may be considered already in the prehospital setting to retain sufficient pleural decompression upon admission.
authors.affiliation: Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. Electronic address: Alexander.Kaserer@usz.ch.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kaserer
authors.affiliation: Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. Electronic address: Philipp.Stein@usz.ch.
authors.forename: Philipp
authors.initials: P
authors.lastname: Stein
authors.affiliation: Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. Electronic address: HansPeter.Simmen@usz.ch.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Simmen
authors.affiliation: Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. Electronic address: Donat.Spahn@usz.ch.
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
authors.affiliation: Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. Electronic address: valentin.neuhaus@gmx.ch.
authors.forename: Valentin
authors.initials: V
authors.lastname: Neuhaus
mesh_terms: D000328:Adult; D019299:Decompression, Surgical / Q000379:methods* / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D011030:Pneumothorax / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D013557:Switzerland; D000069258:Thoracentesis / Q000379:methods* / Q000706:statistics & numerical data; D013898:Thoracic Injuries / Q000150:complications / Q000628:therapy*; D013907:Thoracostomy / Q000379:methods* / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000706:statistics & numerical data
keywords: Chest tube; Needle thoracocentesis; Prehospital intervention; Tension pneumothorax; Thoracic trauma; Tube thoracostomy