Prehospital emergency finger thoracostomy in compensated obstructive shock: Benefits and outcomes

Emergency finger thoracostomy (EFT) has been implemented in several European prehospital settings for intubated and ventilated patients with chest injuries. The indication for intervention in cardiac arrest and peri‑arrest situations is clear. EFT may also be applicable in ventilated but macrohemodynamically compensated patients. This study aims to help prehospital providers understand the benefits and applicability of EFT.

A retrospective analysis was conducted consisting of 114 EFT cases over 53 months. All chest-injured patients had suspected intrapleural pathology and potential compensated obstructive shock state. Two groups were compared: I. Positive clinical finding after EFT: audible air (pneumothorax (PTX)) and/or blood (hemothorax (HTX)) (n = 85); II. Negative clinical finding: no audible air and/or blood escaping during the procedure (n = 29). The primary endpoint was the effect of EFT on the physiologic parameters. The secondary endpoint was the association between intrathoracic pathology observed during EFT and the physiologic effect.

In 75 % of all cases, after EFT, intrapleural pathology was detectable by on-site physical examination. After EFT SpO2 levels increased from 89.6 % (SD 10.7) to 94.9 % (SD 6.7) (p < 0.001). The other physiological parameters did not change significantly (p = 0.346 or higher). In subgroup analysis, there were appreciable increases in SpO2 for those with PTX or PTX with HTX, that were not seen in those with HTX alone or those with negative clinical findings (p < 0.001). No significant adverse effects of EFT were noted during the prehospital phase or in the hospital follow-up period.

EFT performed in ventilated patients with suspected compensated obstructive shock (and stable macrohemodynamic) resulted in audible air and/or blood escape and an improvement in oxygenation if PTX or PTX with HTX were the underlying pathology.

Performing an EFT should be considered not only for deteriorating obstructive shock state but also for potentially compensated shock. Even with diagnostic uncertainty, the benefits of an EFT may outweigh the risks.