Needle versus tube thoracostomy in a swine model of traumatic tension hemopneumothorax.

Abstract

OBJECTIVE:

Traumatic tension hemopneumothorax is fatal if not treated rapidly. However, whether prehospital decompression is better achieved by chest tube or needle thoracostomy is unknown. We conducted this study to compare the immediate results and prolonged effectiveness of two methods of treatment for traumatic tension hemopneumothorax in a swine model.

METHODS:

Ten percent of calculated total blood volume was instilled into the hemithorax of spontaneously ventilating swine (n = 5 per group, 40 +/- 3 kg). A Veres needle and insufflator were used to induce tension hemopneumothorax. Animals were randomized to one of four groups: 1) needle thoracostomy with 14-gauge intravenous catheter; 2) needle thoracostomy with Cook catheter; 3) 32-F chest tube thoracostomy; or 4) no intervention (control). Serial chest x-rays were obtained to document mediastinal shift before and after treatment. Arterial blood gas values and physiologic data were recorded. Postoperatively, thoracoscopy was performed to detect possible pulmonary injury from the procedure and/or catheter kinking or clotting.

RESULTS:

Positive intrapleural pressure was rapidly relieved in all treated animals. Four-hour survival was 100% in the 14-gauge needle and chest tube thoracostomy groups, 60% in the Cook catheter group, and 0% in the control animals (p < 0.05). There were no significant differences in survival or physiologic measurements among the treated animals (p > 0.05).

CONCLUSIONS:

In this animal model, needle thoracostomy using a 14-gauge or Cook catheter was as successful as chest tube thoracostomy for relieving tension hemopneumothorax.

• Authors: John B Holcomb, John G McManus, S T Kerr, Anthony E Pusateri
• Journal: Prehospital emergency care (Prehosp Emerg Care) 2009 Jan-Mar Vol. 13 Issue 1 Pg. 18-27 ISSN: 1545-0066 [Electronic] England
• PMID: 19145520 (Publication Type: Journal Article, Research Support, U.S. Gov't, Non-P.H.S.)

Topics

• Animals
• Chest Tubes
• Disease Models, Animal
• Emergency Medical Services (methods)
• Hemopneumothorax (surgery)
• Humans
• Kaplan-Meier Estimate
• Needles
• Sus scrofa
• Thoracostomy (instrumentation, methods)
• Wounds, Penetrating (complications)