Optimal anatomical location for needle chest decompression for tension pneumothorax: A multicenter prospective cohort study

PRIDE Consortium, N. Azizi, E. ter Avest*, A. E. Hoek, Y. Admiraal-van de Pas, P. J. Buizert, D. R. Peijs, I.H. Berg, A. Rosendaal, T. Boeije, P Rietveld, T. Olgers, J. C. ter Maaten

*Bijbehorende auteur voor dit werk

    OnderzoeksoutputAcademicpeer review

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    Objective: Tension Pneumothorax (TP) can occur as a potentially life threatening complication of chest trauma. Both the 2nd intercostal space in the midclavicular line (ICS2-MCL) and the 4th/5th intercostal space in the anterior axillary line (ICS 4/5-AAL) have been proposed as preferred locations for needle decompression (ND) of a TP. In the present study we aim to determine chest wall thickness (CWT) at ICS2-MCL and ICS4/5-AAL in normal weight-, overweight- and obese patients, and to calculate theoretical success rates of ND for these locations based on standard catheter length.

    Methods: We performed a prospective multicenter study of a convenience sample of adult patients presenting in Emergency Departments (ED) of 2 university hospitals and 6 teaching hospitals participating in the XXX consortium. CWT was measured bilaterally in ISC2-MCL and ISC4/5-AAL with point of care ultrasound (POCUS) and hypothetical success rates of ND were calculated for both locations based on standard equipment used for ND.

    Results: A total of 392 patients was included during a 2 week period. Mean age was 51 years (range 18-89), 52% was male and mean BMI was 25.5 (range 16.3-45.0). Median CWT was 26 [IQR 21-32] (range 9-52) mm in ISC2-MCL, and 26 [21-33] (range 10-78) mm in ICS4/5-AAL (p30, p=0.016 subjects, but not in subjects with a normal BMI. Hypothetical failure rates for 45mm Venflon and 50mm Angiocatheter were 2.5% and 0.8% for ICS2-MCL and 6.2% and 2.5% for ISC4/5-AAL (p=0.016 and p=0.052 respectively).

    Conclusion: In overweight- and obese subjects, the chest wall is thicker in ICS 4/5-AAL than in ICS2-MCL and theoretical chances of successful needle decompression of a tension pneumothorax are significantly higher in ICS2-MCL compared to ICS 4/5-AAL. (C) 2020 The Author(s). Published by Elsevier Ltd.

    Originele taal-2English
    Pagina's (van-tot)213-218
    Aantal pagina's6
    TijdschriftInjury-International Journal of the Care of the Injured
    Volume52
    Nummer van het tijdschrift2
    DOI's
    StatusPublished - feb-2021

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