Needle Thoracostomy in the Prehospital Setting: A Retrospective Observational Study

The use of needle thoracostomy (NT) is a common prehospital intervention for patients in extremis or cardiac arrest due to trauma; however, controversy surrounds its use. The purpose of this study is to compare outcomes, effectiveness, and complications of NT in an Emergency Medical Services (EMS) system that includes urban, rural, and wilderness environments.

This is a retrospective observational study of all patients who had NT performed in a four county EMS system with a catchment area of greater than 1.6 million people. All prehospital records where NT was performed were queried for demographics, mechanism of injury, initial status, and clinical change following NT. Hospital records were queried for exam findings on arrival to the hospital, any complications from NT, and final outcome. The Trauma Registry was accessed to obtain Injury Severity Scores. Information was manually abstracted by study investigators and univariate analysis utilizing chi-squared and two-tailed t-tests were initially conducted before a multivariate analysis was conducted utilizing a binary logistic regression model.

A total of 169 patients with a mean age of 38 years were included in this study; 87% were male and 61% sustained blunt trauma. The overall mortality rate was 79%; 77% in the blunt trauma group; and 83% in the penetrating group, with no significant difference between the two groups relative to mortality (p = 0.336). There was a significant difference in survival between patients who were initially presented as a stat trauma versus as a trauma arrest (52% versus 99%, p > 0.001). The multivariate model with regard to survival supported that reported clinical change after NT (p = 0.001) and status (p = 0.0001) are important indicators of survival. No complications from NT were reported.

NT can safely be performed by paramedics in an EMS system that includes urban, rural, and wilderness settings. Its efficacy does not differ between patients suffering from blunt versus penetrating trauma; however, it appears most beneficial for patients who are unstable but still have vital signs.