Rowan R Sheldon, MD, Michael J Derickson, MD, Woo S Do, MD, Dominic M Forte, MD, Jessica B Weiss, MD, Matthew J Eckert, Matthew J Martin, MD. Madigan Army Medical Center, Tacoma, WA
Objectives: Tension pneumothorax (tPTX) is the second most common cause of preventable death in trauma. Needle decompression is the first-line intervention but has high failure rates. We evaluate the effectiveness and expedience of needle thoracostomy (NT), tube thoracostomy (TT), and Reactor thoracostomy (RT) – a novel spring-loaded trocar insertion device – in a swine model.
Methods: Yorkshire swine underwent controlled thoracic insufflation to create tPTX physiology for all initial experiments. Additional experiments were performed by increasing insufflation pressures to achieve pulseless electrical activity (PEA). Intervention was randomized to NT (14 gauge), TT (32Fr), or RT (36Fr). Air leak was simulated throughout intervention with 40-80mL/kg/min insufflation. Intrathoracic pressure monitoring and hemodynamic parameters obtained at 1 and 5 minutes.
Results: NT was statistically faster at 7.04 +/- 3.04 seconds over either RT at 11.63 +/- 5.30 (p<0.05) or TT at 27.06 +/- 10.73 (p<0.01). When comparing RT to TT, however, no difference was noted. Physiologic decompression was achieved in all patients treated with RT (n=32) and TT (n=32). Only 36% (10/28) of those treated with NT (n = 28) reached this threshold (p<0.01). Return to physiologic baseline occurred in 21% (6/28) of those treated with NT whereas RT or TT demonstrated 88% (28/32) and 94% (30/32) response rates. Overall failure rates of NT amounted to 93% (26/28) in contrast to 13% (4/32) for RT and 6% (2/32) for TT (p<0.01).
Conclusion: NT provides a rapid intervention for tPTX, but is associated with unacceptably high failure rates. RT was effective, easy to use, and may provide a useful and technically simpler alternative intervention as first-line treatment for tPTX or tension-induced PEA.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87172
Program Number: MSS05
Presentation Session: Full-Day Military Surgical Symposium – Basic Science Presentations
Presentation Type: MSSPodium
sages_adbutler_leaderboard