Prehospital decompression of tension pneumothorax: Have we moved the needle?
Needle thoracostomy (NT) is the first-line intervention for tension pneumothorax in the prehospital setting. This study examined the effect of ATLS curriculum and EMS protocol changes on patient selection and successful performance of the procedure. This is a retrospective chart review of all patien...
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| Veröffentlicht in: | The American journal of surgery 2022-12, Vol.224 (6), p.1460-1463 |
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| creator | Osterman, Jordan Kay, Annika Bickford Morris, David S. Evertson, Shawn Brunt, Teresa Majercik, Sarah |
| description | Needle thoracostomy (NT) is the first-line intervention for tension pneumothorax in the prehospital setting. This study examined the effect of ATLS curriculum and EMS protocol changes on patient selection and successful performance of the procedure.
This is a retrospective chart review of all patients presenting to a Level One Trauma Center from 2015 to 2020 after undergoing prehospital NT.
Lateral NT placement increased significantly from 5.1% to 38.9%. Proper patient selection, defined as presence decompensated shock, respiratory distress, and diminished breath sounds increased from 23.1% to 27.8%. There was no difference in radiographic confirmation of the catheter in the pleural space. Iatrogenic injury rates decreased slightly from 28.2% to 16.7%.
Protocol and curriculum changes have fallen short in yielding improved NT success rates or patient selection. Continued development of EMS education on the performance of NT is indicated.
•Needle thoracostomy, continues to be associated with low success rates and poor patient selection.•ATLS curriculum and EMS protocols were changed in 2018 with the goal of improving needle thoracostomy techniques and patient selection.•Technique has improved following those changes, however, success rates and patient selection have not improved. |
| doi_str_mv | 10.1016/j.amjsurg.2022.09.014 |
| format | Article |
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This is a retrospective chart review of all patients presenting to a Level One Trauma Center from 2015 to 2020 after undergoing prehospital NT.
Lateral NT placement increased significantly from 5.1% to 38.9%. Proper patient selection, defined as presence decompensated shock, respiratory distress, and diminished breath sounds increased from 23.1% to 27.8%. There was no difference in radiographic confirmation of the catheter in the pleural space. Iatrogenic injury rates decreased slightly from 28.2% to 16.7%.
Protocol and curriculum changes have fallen short in yielding improved NT success rates or patient selection. Continued development of EMS education on the performance of NT is indicated.
•Needle thoracostomy, continues to be associated with low success rates and poor patient selection.•ATLS curriculum and EMS protocols were changed in 2018 with the goal of improving needle thoracostomy techniques and patient selection.•Technique has improved following those changes, however, success rates and patient selection have not improved.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2022.09.014</identifier><identifier>PMID: 36210204</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Catheters ; Curricula ; Decompression ; Decompression, Surgical ; Documentation ; Emergency medical care ; Emergency Medical Services - methods ; Humans ; Hypotension ; Iatrogenesis ; Medical instruments ; Needle decompression ; Needle thoracostomy ; Needles ; Patients ; Physiology ; Pneumothorax ; Pneumothorax - surgery ; Prehospital ; Retrospective Studies ; Tension pneumothorax ; Thoracostomy - methods ; Trauma ; Trauma centers ; Vital signs</subject><ispartof>The American journal of surgery, 2022-12, Vol.224 (6), p.1460-1463</ispartof><rights>2022 Elsevier Inc.</rights><rights>Copyright © 2022 Elsevier Inc. All rights reserved.</rights><rights>2022. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c323t-a02bc30641126340825ac8644f42d4108bd1d33b552d74f00dc8880d23fb262a3</citedby><cites>FETCH-LOGICAL-c323t-a02bc30641126340825ac8644f42d4108bd1d33b552d74f00dc8880d23fb262a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S000296102200561X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36210204$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Osterman, Jordan</creatorcontrib><creatorcontrib>Kay, Annika Bickford</creatorcontrib><creatorcontrib>Morris, David S.</creatorcontrib><creatorcontrib>Evertson, Shawn</creatorcontrib><creatorcontrib>Brunt, Teresa</creatorcontrib><creatorcontrib>Majercik, Sarah</creatorcontrib><title>Prehospital decompression of tension pneumothorax: Have we moved the needle?</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Needle thoracostomy (NT) is the first-line intervention for tension pneumothorax in the prehospital setting. This study examined the effect of ATLS curriculum and EMS protocol changes on patient selection and successful performance of the procedure.
This is a retrospective chart review of all patients presenting to a Level One Trauma Center from 2015 to 2020 after undergoing prehospital NT.
Lateral NT placement increased significantly from 5.1% to 38.9%. Proper patient selection, defined as presence decompensated shock, respiratory distress, and diminished breath sounds increased from 23.1% to 27.8%. There was no difference in radiographic confirmation of the catheter in the pleural space. Iatrogenic injury rates decreased slightly from 28.2% to 16.7%.
Protocol and curriculum changes have fallen short in yielding improved NT success rates or patient selection. Continued development of EMS education on the performance of NT is indicated.
•Needle thoracostomy, continues to be associated with low success rates and poor patient selection.•ATLS curriculum and EMS protocols were changed in 2018 with the goal of improving needle thoracostomy techniques and patient selection.•Technique has improved following those changes, however, success rates and patient selection have not improved.</description><subject>Catheters</subject><subject>Curricula</subject><subject>Decompression</subject><subject>Decompression, Surgical</subject><subject>Documentation</subject><subject>Emergency medical care</subject><subject>Emergency Medical Services - methods</subject><subject>Humans</subject><subject>Hypotension</subject><subject>Iatrogenesis</subject><subject>Medical instruments</subject><subject>Needle decompression</subject><subject>Needle thoracostomy</subject><subject>Needles</subject><subject>Patients</subject><subject>Physiology</subject><subject>Pneumothorax</subject><subject>Pneumothorax - surgery</subject><subject>Prehospital</subject><subject>Retrospective Studies</subject><subject>Tension pneumothorax</subject><subject>Thoracostomy - methods</subject><subject>Trauma</subject><subject>Trauma centers</subject><subject>Vital signs</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkE1v1DAQhi1ERbeFnwCKxIVLwnjsTRwuVVX1A2klOMDZcuwJmyiJg50s8O_rsgsHLpxmRnremdHD2GsOBQdevu8LM_ZxDd8KBMQC6gK4fMY2XFV1zpUSz9kGADCvSw7n7CLGPo2cS_GCnYsSOSDIDdt9DrT3ce4WM2SOrB_nQDF2fsp8my00_W7nidbRL3sfzM8P2YM5UPaDstEfyGXLnrKJyA109ZKdtWaI9OpUL9nXu9svNw_57tP9x5vrXW4FiiU3gI0VUErOsRQSFG6NVaWUrUQnOajGcSdEs92iq2QL4KxSChyKtsESjbhk74575-C_rxQXPXbR0jCYifwaNVYoZPKAPKFv_0F7v4YpfZcoWdXAK1EmanukbPAxBmr1HLrRhF-ag37SrXt90q2fdGuoddKdcm9O29dmJPc39cdvAq6OACUdh46CjrajyZLrAtlFO9_958QjoKCR3g</recordid><startdate>202212</startdate><enddate>202212</enddate><creator>Osterman, Jordan</creator><creator>Kay, Annika Bickford</creator><creator>Morris, David S.</creator><creator>Evertson, Shawn</creator><creator>Brunt, Teresa</creator><creator>Majercik, Sarah</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202212</creationdate><title>Prehospital decompression of tension pneumothorax: Have we moved the needle?</title><author>Osterman, Jordan ; Kay, Annika Bickford ; Morris, David S. ; Evertson, Shawn ; Brunt, Teresa ; Majercik, Sarah</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c323t-a02bc30641126340825ac8644f42d4108bd1d33b552d74f00dc8880d23fb262a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Catheters</topic><topic>Curricula</topic><topic>Decompression</topic><topic>Decompression, Surgical</topic><topic>Documentation</topic><topic>Emergency medical care</topic><topic>Emergency Medical Services - methods</topic><topic>Humans</topic><topic>Hypotension</topic><topic>Iatrogenesis</topic><topic>Medical instruments</topic><topic>Needle decompression</topic><topic>Needle thoracostomy</topic><topic>Needles</topic><topic>Patients</topic><topic>Physiology</topic><topic>Pneumothorax</topic><topic>Pneumothorax - surgery</topic><topic>Prehospital</topic><topic>Retrospective Studies</topic><topic>Tension pneumothorax</topic><topic>Thoracostomy - methods</topic><topic>Trauma</topic><topic>Trauma centers</topic><topic>Vital signs</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Osterman, Jordan</creatorcontrib><creatorcontrib>Kay, Annika Bickford</creatorcontrib><creatorcontrib>Morris, David S.</creatorcontrib><creatorcontrib>Evertson, Shawn</creatorcontrib><creatorcontrib>Brunt, Teresa</creatorcontrib><creatorcontrib>Majercik, Sarah</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Osterman, Jordan</au><au>Kay, Annika Bickford</au><au>Morris, David S.</au><au>Evertson, Shawn</au><au>Brunt, Teresa</au><au>Majercik, Sarah</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prehospital decompression of tension pneumothorax: Have we moved the needle?</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2022-12</date><risdate>2022</risdate><volume>224</volume><issue>6</issue><spage>1460</spage><epage>1463</epage><pages>1460-1463</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><abstract>Needle thoracostomy (NT) is the first-line intervention for tension pneumothorax in the prehospital setting. This study examined the effect of ATLS curriculum and EMS protocol changes on patient selection and successful performance of the procedure.
This is a retrospective chart review of all patients presenting to a Level One Trauma Center from 2015 to 2020 after undergoing prehospital NT.
Lateral NT placement increased significantly from 5.1% to 38.9%. Proper patient selection, defined as presence decompensated shock, respiratory distress, and diminished breath sounds increased from 23.1% to 27.8%. There was no difference in radiographic confirmation of the catheter in the pleural space. Iatrogenic injury rates decreased slightly from 28.2% to 16.7%.
Protocol and curriculum changes have fallen short in yielding improved NT success rates or patient selection. Continued development of EMS education on the performance of NT is indicated.
•Needle thoracostomy, continues to be associated with low success rates and poor patient selection.•ATLS curriculum and EMS protocols were changed in 2018 with the goal of improving needle thoracostomy techniques and patient selection.•Technique has improved following those changes, however, success rates and patient selection have not improved.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36210204</pmid><doi>10.1016/j.amjsurg.2022.09.014</doi><tpages>4</tpages></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Catheters Curricula Decompression Decompression, Surgical Documentation Emergency medical care Emergency Medical Services - methods Humans Hypotension Iatrogenesis Medical instruments Needle decompression Needle thoracostomy Needles Patients Physiology Pneumothorax Pneumothorax - surgery Prehospital Retrospective Studies Tension pneumothorax Thoracostomy - methods Trauma Trauma centers Vital signs |
| title | Prehospital decompression of tension pneumothorax: Have we moved the needle? |
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