Highlights
- •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
Background
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.
Methods
This is a retrospective chart review of all patients presenting to a Level One Trauma
Center from 2015 to 2020 after undergoing prehospital NT.
Results
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%.
Conclusions
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.
Keywords
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References
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Article info
Publication history
Published online: September 23, 2022
Accepted:
September 12,
2022
Received in revised form:
July 31,
2022
Received:
March 26,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
