Relative device stability of anterior vs. axillary needle decompression for tension pneumothorax during casualty movement: Preliminary analysis of a human cadaver model.

BACKGROUND: Tension pneumothorax (tPTX) remains a significant cause of potentially preventable death in military and civilian settings. The current pre-hospital standard of care for tPTX is immediate decompression with a 14 gauge 8cm angiocatheter (14G AC); however, failure rates may be as high as 17-60%. Alternative devices, such as 10G AC, modified Veress needle (mVN) and laparoscopic trocar (LT), have shown to be potentially more effective in animal models; however, little is known about the relative insertional safety or mechanical stability during casualty movement. METHODS: Seven soft-embalmed cadavers were intubated and mechanically ventilated. Chest wall thickness (CWT) was measured at the 2nd intercostal space (ICS) at the midclavicular line (2MCL) and the 5th ICS along the anterior axillary line (5AAL). CO2 insufflation created a PTX and needle decompression was then performed with a randomized device. Insertional depth was measured between hub and skin before and after simulated casualty transport. Thoracoscopy was used to evaluate for intrapleural placement and/or injury during insertion and after movement. Cadaver demographics, device displacement, device dislodgment, and injuries were recorded. Three decompressions were performed at each site (2MCL/5AAL), totaling 12 events per cadaver. RESULTS: 84 decompressions were performed. Average cadaver age was 59 years old and BMI was 24 kg/m2. The CWT varied between cadavers due to subcutaneous emphysema, but the average was 39mm at the 2MCL and 31mm at the 5AAL. Following movement, the 2MCL site was more likely to become dislodged than the 5AAL (67% vs 17%, p=0.001). Median displacement also differed between 2MCL and 5AAL (23mm vs 2mm, p=0.001). No significant differences were noted in dislodgement or displacement between devices. Five minor lung injuries were noted at the 5AAL position. CONCLUSION: Preliminary results from this human cadaver study suggest the 5AAL position is a more stable and reliable location for thoracic decompression of tPTX during combat casualty transport. Level III, therapeutic (C) 2017 Lippincott Williams & Wilkins, Inc.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2niv8PT