Emergency thoracostomy as a safe and effective intervention in prehospital trauma

A five year experience from the Hungarian Air Ambulance


Traumatic tension pneumothorax is one of the most frequent causes of early mortality among the severely injured. Different methods are recommended for chest decompression. The aim of this study is to examine whether emergency thoracostomy can improve the real 30-day survival compared to the expected Revised Trauma Score (RTS) based survival, the Return of Spontaneous Circulation (ROSC) rate in Traumatic Cardiac Arrest (TCA), reduce the occurrence of tension pneumothorax (tPTX) and to determine the complication rate of the intervention. 


American College of Surgeons. Committee on Trauma. ATLS. Advanced trauma life support for doctors: student course manual. 10th ed. Chicago: American College of Surgeons; 2018.

Aylwin CJ, Brohi K, Davies GD, Walsh MS. Pre-hospital and in-hospital thoracostomy: indications and complications. Ann R Coll Surg Engl. 2008. 90(1): 54-57. https://doi.org/10.1308/003588408X242286

Bailey RC. Complications of tube thoracostomy in trauma. J Accid Emerg Med. 2000. 17(2): 111-114. https://doi.org/10.1136/emj.17.2.111

Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989. 29(5): 623-629. https://doi.org/10.1097/00005373-198905000-00017

Chan L, Reilly KM, Henderson C, Kahn F, Salluzzo RF. Complication rates of tube thoracostomy. Am J Emerg Med. 1997. 15(4): 368-370. https://doi.org/10.1016/S0735-6757(97)90127-3

Deakin CD, Davies G, Wilson A. Simple thoracostomy avoids chest drain insertion in prehospital trauma. J Trauma. 1995. 39(2): 373-374. https://doi.org/10.1097/00005373-199508000-00031

Eddy AC, Luna GK, Copass M. Empyema thoracis in patients undergoing emergent closed tube thoracostomy for thoracic trauma. Am J Surg. 1989. 157(5): 494-497. https://doi.org/10.1016/0002-9610(89)90643-0

Etoch SW, Bar-Natan MF, Miller FB, Richardson JD. Tube thoracostomy. Factors related to complications. Arch Surg. 1995. 130(5): 521-525.; discussion 525-6. https://doi.org/10.1001/archsurg.1995.01430050071012

Fitzgerald M, Mackenzie CF, Marasco S, Hoyle R, Kossmann T. Pleural decompression and drainage during trauma reception and resuscitation. Injury. 2008. 39(1): 9-20. https://doi.org/10.1016/j.injury.2007.07.021

Givens ML, Ayotte K, Manifold C. Needle thoracostomy: implications of computed tomography chest wall thickness. Acad Emerg Med. 2004 Feb;11(2):211-3. https://doi.org/10.1111/j.1553-2712.2004.tb01439.x

Havelock T, Teoh R, Laws D, Gleeson F; BTS Pleural Disease Guideline Group. Pleural procedures and thoracic ultrasound: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010. 65. Suppl 2: ii61-76. https://doi.org/10.1136/thx.2010.137026

Heydari-Khayat N, Sharifipoor CH, Rezaei MA, Mohammadinia N, Darban F. Correlation of Revised Trauma Score with mortality rate of traumatic patients within the first 24 hours of hospitalization. Zahedan Journal of Research in Medical Sciences. 2014. 16(11): 33-36.

Huber-Wagner S, Lefering R, Qvick M, Kay MV, Paffrath T, Mutschler W, Kanz KG; Working Group on Polytrauma of the German Trauma Society (DGU). Outcome in 757 severely injured patients with traumatic cardiorespiratory arrest. Resuscitation. 2007. 75(2): 276-285. https://doi.org/10.1016/j.resuscitation.2007.04.018

Iribhogbe PE, Uwuigbe O. Complications of tube thoracostomy using Advanced Trauma Life Support technique in chest trauma. West Afr J Med. 2011. 30(5): 369-372.

Jones R, Hollingsworth J. Tension pneumothoraces not responding to needle thoracocentesis. Emerg Med J. 2002. 19(2): 176-177. https://doi.org/10.1136/emj.19.2.176

Leigh-Smith S, Harris T. Tension pneumothorax--time for a re-think? Emerg Med J. 2005. 22(1): 8-16. https://doi.org/10.1136/emj.2003.010421

Lesperance RN, Carroll CM, Aden JK, Young JB, Nunez TC. Failure rate of prehospital needle decompression for tension pneumothorax in trauma patients. Am Surg. 2018. 84(11): 1750-1755. https://doi.org/10.1177/000313481808401130

Lockey D, Crewdson K, Davies G. Traumatic cardiac arrest: who are the survivors? Ann Emerg Med. 2006. 48(3): 240-244. https://doi.org/10.1016/j.annemergmed.2006.03.015

Lott C, Truhlář A, Alfonzo A, Barelli A, González-Salvado V, Hinkelbein J, Nolan JP, Paal P, Perkins GD, Thies KC, Yeung J, Zideman DA, Soar J; ERC Special Circumstances Writing Group Collaborators. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation. 2021. 161: 152-219. https://doi.org/10.1016/j.resuscitation.2021.02.011

Manoochehry S, Vafabin M, Bitaraf S, Amiri A. A Comparison between the Ability of Revised Trauma Score and Kampala Trauma Score in Predicting Mortality; a Meta-Analysis. Arch Acad Emerg Med. 2019. 7(1): e6.

Mansour DA, Abou Eisha HA, Asaad AE. Validation of revised trauma score in the emergency department of Kasr Al Ainy. Egypt J Surg. 2019. 38(4): 679-684.

Menger R, Telford G, Kim P, Bergey MR, Foreman J, Sarani B, Pascual J, Reilly P, Schwab CW, Sims CA. Complications following thoracic trauma managed with tube thoracostomy. Injury. 2012. 43(1): 46-50. https://doi.org/10.1016/j.injury.2011.06.420

Molnar TF. Thoracic trauma: Which chest tube when and where? Thorac Surg Clin. 2017. 27(1): 13-23. https://doi.org/10.1016/j.thorsurg.2016.08.003

Rottenstreich M, Fay S, Gendler S, Klein Y, Arkovitz M, Rottenstreich A. Needle Thoracotomy in Trauma. Mil Med. 2015 Dec;180(12):1211-3. https://doi.org/10.7205/MILMED-D-14-00730

Smith J, Greaves I, Porter KM. Oxford desk reference – Major trauma. Oxford. Oxford University Press. 2011. p. 67-94. https://doi.org/10.1093/med/9780199543328.001.0001

Stevens RL, Rochester AA, Busko J, Blackwell T, Schwartz D, Argenta A, Sing RF. Needle thoracostomy for tension pneumothorax: failure predicted by chest computed tomography. Prehosp Emerg Care. 2009. 13(1): 14-17. https://doi.org/10.1080/10903120802471998

Wernick B, Hon HH, Mubang RN, Cipriano A, Hughes R, Rankin DD, Evans DC, Burfeind WR Jr, Hoey BA, Cipolla J, Galwankar SC, Papadimos TJ, Stawicki SP, Firstenberg MS. Complications of needle thoracostomy: A comprehensive clinical review. Int J Crit Illn Inj Sci. 2015. 5(3): 160-169. https://doi.org/10.4103/2229-5151.164939

Zengerink I, Brink PR, Laupland KB, Raber EL, Zygun D, Kortbeek JB. Needle thoracostomy in the treatment of a tension pneumothorax in trauma patients: what size needle? J Trauma. 2008. 64(1): 111-114. https://doi.org/10.1097/01.ta.0000239241.59283.03

Folyóirat szám
Eredeti cikk