Long AN, Achay J, Hudson IL, Lowe JB, Epley E, Bolleter S, DeSoucy ES, Hewitt CW, Rollman JE, Swenson JF, Wampler D, Raetz E, Kruse A. Ahead of Print. (Journal Article)
Abstract
Background: Needle decompression (NDC) is the primary treatment of tension pneumothorax (tPTX) in prehospital settings. This study compared 10-gauge (10ga) and 14-gauge (14ga) fenestrated needle/catheter units for NDC. We hypoth-esized 10ga needle/catheter units would demonstrate higher tPTX decompression rates compared to 14ga needle/catheter units. Methods: A non-randomized, non-blinded study was conducted using human cadavers with artificially induced tPTX (pleural pressure of 15mmHg). A 10ga or 14ga unit was in-serted into the 5th intercostal space, anterior axillary line, or the 2nd intercostal space, midclavicular line. Successful NDC was defined as a pressure decrease to less than 4mmHg. Results: In 116 NDC attempts, there was no difference in the success rate of NDC between 10ga versus 14ga units (91.1% vs. 91.1%, P=1.0). The median time to decompression of tPTX was faster using 10ga at 22.0s (IQR 14.5-42.0) vs. 14ga at 39.8 seconds (IQR 30.3-57.6, P<.001). No difference was found in time to successful decompression between AAL and MCL sites (36.0s [IQR 21.7-51.7] vs. 30.4s [IQR 18.7-49.5], P=.46). The 10ga needle/catheter units achieved an audible release of air with the needle still in place during successful NDC more frequently compared to the 14ga units (65.3% vs. 34.7%; P=.034). Con-clusion: NDC with 10ga fenestrated needle/catheter units was similarly effective, but significantly faster than 14ga units for tPTX in a cadaveric model. A safe, depth-limiting technique was over 90% effective across all NDC sites.
Keywords: tension pneumothorax; needle thoracostomy; decompression; cadaver; needle gauge; gauge size