Comparison of needle decompression to simple (finger) thoracostomy in non-perfused cadaveric models with theoretical tension pneumothorax.

OBJECTIVES: Tension pneumothorax is treated by performing a needle decompression or simple thoracostomy. Failures with needle decompression include incorrect identification of landmarks, body habitus, inserting the needle too deep or not deep enough. Recently, the use of simple thoracostomy has been increasing in frequency by both air medical and ground-based emergency medical services (EMS) systems. The objective of this study is to compare the effectiveness of needle decompression to simple thoracostomy in a theoretical tension pneumothorax created in a cadaveric model. METHODS: We used a prospective, simulation-based experimental crossover study design utilizing fresh, never-frozen human cadavers to determine the differences between needle decompression and simple thoracostomy for the treatment of tension pneumothorax. A theoretical tension pneumothorax was created by placing a catheter into the pleural space and connecting a three-way stopcock, digital manometer, and inflation bulb. A 10-gauge decompression needle was introduced into the chest. Next, after reinflation a simple thoracostomy was performed on the cadaver. The manometer was monitored in both instances to determine if the tension pneumothorax was relieved completely. RESULTS: Needle decompression successfully resolved the tension pneumothorax in 29/38 attempts (76.3%), and simple thoracostomy successfully resolved the tension pneumothorax in 35/38 attempts (92.1%) to a value of less than 4 mmHg. Needle decompression completely relieved the intrapleural pressure to a value of 0mmHg in 11/38 attempts (28.9%) and simple thoracostomy relieved the intrapleural pressure to a value of 0mmHg in 23/38 attempts (60.5%); p = 0.004. The mean time to cessation of air release with needle decompression was 34.1 ± 22.2 seconds; the mean time to cessation of air release with simple thoracostomy was 11.9 ± 11.4 seconds; p < 0.001. CONCLUSIONS: Simple thoracostomy was successful in 92.1% of the attempts to relieve the tension pneumothorax, whereas needle decompression was successful in 76.3% of the attempts. Simple thoracostomy was also faster at relieving the tension pneumothorax completely, although this is of undetermined significance. All of these results are based on a theoretical tension pneumothorax cadaveric model. EMS clinicians should still maintain a reasonable level of suspicion for unrelieved tension pneumothorax after performing a needle decompression on trauma patients.