Document Type

Article

Publication Date

4-3-2024

Publication Title

International Journal of Paramedicine

Abstract

Introduction: Tension pneumothorax related to chest trauma is a rapidly lethal condition that requires immediate treatment, often prior to arrival at definitive ca.re. Recent concerns regarding the safety and efficacy of needle thoracostomy (NT) have led to alternatives. Finger thoracostomy (FT) is a potential life-sav­ing treatment performed by prehospital providers as an alternative to NT. We hypothesize that FT has improved rates of prehospital thoracic decompression and is a safe alternative to NT. Materials and Methods: Retrospective cohort study of consecutive adult trauma patients presenting to a Level 1 trauma center who sustained chest trauma. A matched cohort of patients with an initial prehospital treatment with FT was compared to patients who underwent prehospital NT for thoracic decompres­sion. Wilcoxon Rank Sum Test and Chi-Squared Analyses were performed for comparison of prehospital and in-hospital outcome variables. Results: 34 patients were compared, of which 15 underwent prehospital FT and 19 underwent prehospital NT. Groups were well matched in terms of demograph­ics and injury characteristics. No difference in transport times were observed. All 15 patients in the FT group sustained cardiac arrest prior to arrival with 20% achieving return of spontaneous circulation (ROSC), while 6/19 NT patients arrived in cardiac arrest, with 66.7% achieving ROSC (p=0.04). The rate of suc­cessful intrathoracic decompression was higher in the FT group (93.3% vs 47.4%, p < 0.001). The NT group had a higher rate of chest tube placement (p=0.005). in-hospital mortality was not different between the two groups (p=0.213). Conclusions: FT is a viable alternative to NT for emergent thoracic decompression. The higher success rate of intrathoracic decompression supports the use of FT as a primary or second line treatment to NT for prehospital tension pneumo­thorax, although future studies a.re needed to establish superiority and further evaluate mortality and in-hospital outcomes.

Issue

6

Publisher

National EMS Management Association

Creative Commons License

Creative Commons Attribution-No Derivative Works 4.0 International License
This work is licensed under a Creative Commons Attribution-No Derivative Works 4.0 International License.

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