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Updated: Oct 22, 2025

Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion

Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion

Published on: November 10, 2023

Prehospital paramedic pleural decompression: A systematic review.

Ms Kelsey Sharrock¹, Brendan Shannon¹, Carlos Garcia Gonzalez²

¹Department of Paramedicine, Monash University, Melbourne, Australia; Ambulance Victoria, Doncaster, Melbourne, Australia.

|August 29, 2021

Summary

Paramedics use needle thoracostomy (NT) and finger thoracostomy (FT) for tension pneumothorax (TPT). Limited evidence suggests both are safe, but complications exist. More research is needed to determine superiority for prehospital TPT treatment.

Keywords:

Ension pneumothorax Finger thoracostomy Needle thoracostomy Paramedics Pleural decompression Prehospital Tension pneumothorax

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Area of Science:

Emergency Medicine
Trauma Surgery
Prehospital Care

Background:

Tension pneumothorax (TPT) is a life-threatening condition following thoracic injury.
Rapid pleural cavity decompression is crucial for survival.
Paramedics utilize needle thoracostomy (NT) and finger thoracostomy (FT) in prehospital settings, but their comparative effectiveness is unknown.

Purpose of the Study:

To compare procedural success, complications, and mortality between NT and FT for suspected TPT in the prehospital setting.
To evaluate the effectiveness of paramedic-performed NT versus FT.

Main Methods:

A systematic search of four databases (Ovid Medline, PubMed, CINAHL, Embase) was conducted up to August 25, 2020.
Studies included patients with suspected TPT treated prehospital by paramedics using NT or FT.
Nineteen studies were included for final analysis, predominantly retrospective.

Main Results:

Mortality rates varied widely: 12.5%-79% for NT and 64.7%-92.9% for FT.
Complications were higher with NT (13.7%) compared to FT (4.8%).
Success was defined by improved vital signs, successful pleural access, and absence of TPT upon hospital arrival.

Conclusions:

Evidence on prehospital TPT decompression by paramedics is limited.
Both FT and NT appear safe for pleural decompression but carry associated risks.
High-quality comparative studies are needed to determine the superior procedure for prehospital TPT management.