Trauma Video Review: Tube Thoracostomy Placement in Hemodynamically Stable versus Unstable Patients

Tube thoracostomy (TT) is a critical procedure in trauma resuscitation, yet little is known about how patient hemodynamics affects the timing of and placement technique during resuscitation. Trauma Video Review offers an objective tool to analyze procedural quality and identify areas for improvement. We hypothesized that hemodynamically unstable patients would experience more efficient, though less sterile TT placement.

In this single-center, observational study, we reviewed audiovisual recordings of trauma resuscitations (June 2024-January 2025) at a level 1 trauma center. We abstracted patient demographics, hemodynamic parameters, TT indication, procedural steps, timing metrics, antibiotic use, and sterile technique compliance. Patients were categorized as hemodynamically stable (HDS) or unstable (HDU), with HDU defined as SBP < 90, HR > 120, or RR > 24, and groups were compared.

Thirty one TT placements in 28 patients were analyzed (median age 37 y, 50% penetrating injuries). While most patients received appropriate antibiotics (91% HDS, 75% HDU, P = 0.28), only two procedures were performed under complete sterile conditions. Timing metrics, including decision to place TT (3.4 versus 2.2 min, P = 0.65), preparation (8.7 versus 7.1 min, P = 0.17), and procedure duration (4.6 versus 3.1 min, P = 0.25), did not differ significantly between groups. However, total procedural time, from plan verbalization to functional TT, was significantly shorter in HDU patients (15.3 versus 22.7 min, P = 0.02).

While maintaining similar quality metrics for individual procedural components, trauma teams placed TTs more efficiently in HDU patients. The low compliance with sterile technique, despite good antibiotic administration, identifies a clear target for quality improvement initiatives.