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. 2016 Feb;80(2):272-7.
doi: 10.1097/TA.0000000000000889.

Needle thoracostomy: Clinical effectiveness is improved using a longer angiocatheter

Johnathon M Aho  1 , Cornelius A Thiels, Moustafa M El Khatib, Daniel S Ubl, Danuel V Laan, Kathleen S Berns, Elizabeth B Habermann, Scott P Zietlow, Martin D Zielinski
Affiliations

Needle thoracostomy: Clinical effectiveness is improved using a longer angiocatheter

Johnathon M Aho et al. J Trauma Acute Care Surg. 2016 Feb.

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.

Conclusion: Eight-centimeter angiocatheters are more effective at chest decompression compared with currently recommended 5 cm at the second intercostal space midclavicular line.

Level of evidence: Therapeutic study, level IV.

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Figures

Figure 1
Figure 1
Study flowchart of needle thoracostomy patients, detailing inclusion criterial, timing of equipment change, and needle thoracostomy placement setting.
Figure 2
Figure 2
Documented needle thoracostomy by effectiveness by category in 70 patients. Effectiveness was defined as documented clinical improvement in respiratory, cardiovascular, or general clinical condition.
Figure 3
Figure 3
(A.) Radiographically predicted effectiveness of 5cm and 8cm catheters in the 2nd ICS-MCL and (B) 4th ICS-MAL. (C.) Actual effectiveness of 5cm and 8cm catheters at the 2nd ICS-MCL. BMI and CWT for each group graphed as R2.
See this image and copyright information in PMC

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