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Sufficient Catheter Length for Pneumothorax Needle Decompression: A Meta-Analysis

Published online by Cambridge University Press:  10 April 2015

Brian M. Clemency ,
Christopher T. Tanski ,
Michael Rosenberg ,
Paul R. May ,
Joseph D. Consiglio  and
Heather A. Lindstrom
Brian M. Clemency*
Affiliation:
University at Buffalo, Department of Emergency Medicine, Buffalo, New York USA
Christopher T. Tanski
Affiliation:
State University of New York Upstate Medical University, Department of Emergency Medicine, Syracuse New York USA
Michael Rosenberg
Affiliation:
University at Albany, School of Public Health, Albany, New York USA
Paul R. May
Affiliation:
University at Buffalo, Department of Emergency Medicine, Buffalo, New York USA
Joseph D. Consiglio
Affiliation:
John Carroll University, Department of Mathematics and Computer Science, Cleveland, Ohio USA
Heather A. Lindstrom
Affiliation:
University at Buffalo, Department of Emergency Medicine, Buffalo, New York USA
*
Correspondence: Brian M. Clemency, DO Department of Emergency Medicine Erie County Medical Center 462 Grider St. Buffalo, New York 14215 USA E-mail: [email protected]
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Abstract

Introduction

Needle thoracostomy is the prehospital treatment for tension pneumothorax. Sufficient catheter length is necessary for procedural success. The authors of this study determined minimum catheter length needed for procedural success on a percentile basis.

Methods

A meta-analysis of existing studies was conducted. A Medline search was performed using the search terms: needle decompression, needle thoracentesis, chest decompression, pneumothorax decompression, needle thoracostomy, and tension pneumothorax. Studies were included if they published a sample size, mean chest wall thickness, and a standard deviation or confidence interval. A PubMed search was performed in a similar fashion. Sample size, mean chest wall thickness, and standard deviation were found or calculated for each study. Data were combined to create a pooled dataset. Normal distribution of data was assumed. Procedural success was defined as catheter length being equal to or greater than the chest wall thickness.

Results

The Medline and PubMed searches yielded 773 unique studies; all study abstracts were reviewed for possible inclusion. Eighteen papers were identified for full manuscript review. Thirteen studies met all inclusion criteria and were included in the analysis. Pooled sample statistics were: n=2,558; mean=4.19 cm; and SD=1.37 cm. Minimum catheter length needed for success at the 95th percentile for chest wall size was found to be 6.44 cm.

Discussion

A catheter of at least 6.44 cm in length would be required to ensure that 95% of the patients in this pooled sample would have penetration of the pleural space at the site of needle decompression, and therefore, a successful procedure. These findings represent Level III evidence.

ClemencyBM , TanskiCT , RosenbergM , MayPR , ConsiglioJD , LindstromHA . Sufficient Catheter Length for Pneumothorax Needle Decompression: A Meta-Analysis. Prehosp Disaster Med. 2015;30(3):1 5

Keywords

needle decompressionpneumothoraxprehospitalthoracostomy
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 30 , Issue 3 , June 2015 , pp. 249 - 253
Copyright
© World Association for Disaster and Emergency Medicine 2015 

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References

1. Eckstein, M, Suyehara, D. Needle thoracostomy in the prehospital setting. Prehosp Emerg Care. 1998;2(2):132-135.Google Scholar
2. Warner, KJ, Copass, MK, Bulger, EM. Paramedic use of needle thoracostomy in the prehospital environment. Prehosp Emerg Care. 2008;12(2):162-168.Google Scholar
3. Cullinane, DC, Morris, JA Jr., Bass, JG, Rutherford, EJ. Needle thoracostomy may not be indicated in the trauma patient. Injury. 2001;32(10):749-752.Google Scholar
4. Barton, ED, Epperson, M, Hoyt, DB, Fortlage, D, Rosen, P. Prehospital needle aspiration and tube thoracostomy in trauma victims: a six-year experience with aeromedical crews. J Emerg Med. 1995;13(2):155-163.Google Scholar
5. Ball, CG, Wyrzykowski, AD, Kirkpatrick, AW, et al. Thoracic needle decompression for tension pneumothorax: clinical correlation with catheter length. Can J Surg. 2010;53(3):184-188.Google Scholar
6. Inaba, K, Branco, BC, Eckstein, M, et al. Optimal positioning for emergent needle thoracostomy: a cadaver-based study. J Trauma. 2011;71(5):1099-1103.Google ScholarPubMed
7. American College of Surgeons’ Committee on Trauma. Advanced Trauma Life Support Student Course Manual. 9th ed. Chicago, Illinois USA: American College of Surgeons; 2012.Google Scholar
8. Alson, R, Braithwaite, S. International trauma life support: needle decompression of tension pneumothorax: International Trauma Life Support; 2014. https://www.itrauma.org/wp-content/uploads/2014/07/Needle-Decompression-Resource-Document-FINAL-Publication-6-28-14.pdf. Accessed September 30, 2014.Google Scholar
9. NAEMT, American College of Surgeons’ Committee on Trauma. PHTLS Prehospital Trauma Life Support. 7th ed. Burlington, Massachusetts USA: Jones & Bartlett Learning, LLC; 2011.Google Scholar
10. Stevens, RL, Rochester, AA, Busko, J, et al. Needle thoracostomy for tension pneumothorax: failure predicted by chest computed tomography. Prehosp Emerg Care. 2009;13(1):14-17.Google Scholar
11. Chang, SJ, Ross, SW, Kiefer, DJ, et al. Evaluation of 8.0-cm needle at the fourth anterior axillary line for needle chest decompression of tension pneumothorax. J Trauma Acute Care Surg. 2014;76(4):1029-1034.CrossRefGoogle Scholar
12. Akoglu, H, Akoglu, EU, Evman, S, et al. Determination of the appropriate catheter length and place for needle thoracostomy by using computed tomography scans of pneumothorax patients. Injury. 2013;44(9):1177-1182.Google Scholar
13. Carter, TE, Mortensen, CD, Kaistha, S, Conrad, C, Dogbey, G. Needle decompression in appalachia do obese patients need longer needles? West J Emerg Med. 2013;14(6):650-652.CrossRefGoogle ScholarPubMed
14. Givens, ML, Ayotte, K, Manifold, C. Needle thoracostomy: implications of computed tomography chest wall thickness. Acad Emerg Med. 2004;11(2):211-213.CrossRefGoogle ScholarPubMed
15. Harcke, HT, Pearse, LA, Levy, AD, Getz, JM, Robinson, SR. Chest wall thickness in military personnel: implications for needle thoracentesis in tension pneumothorax. Mil Med. 2007;172(12):1260-1263.Google Scholar
16. Inaba, K, Ives, C, McClure, K, et al. Radiologic evaluation of alternative sites for needle decompression of tension pneumothorax. Arch Surg. 2012;147(9):813-818.Google Scholar
17. McLean, AR, Richards, ME, Crandall, CS, Marinaro, JL. Ultrasound determination of chest wall thickness: implications for needle thoracostomy. Am J Emerg Med. 2011;29(9):1173-1177.CrossRefGoogle ScholarPubMed
18. Powers, WF, Clancy, TV, Adams, A, West, TC, Kotwall, CA, Hope, WW. Proper catheter selection for needle thoracostomy: a height and weight-based criteria. Injury. 2014;45(1):107-111.Google Scholar
19. Sanchez, LD, Straszewski, S, Saghir, A, et al. Anterior versus lateral needle decompression of tension pneumothorax: comparison by computed tomography chest wall measurement. Acad Emerg Med. 2011;18(10):1022-1026.Google Scholar
20. Schroeder, E, Valdez, C, Krauthamer, A, et al. Average chest wall thickness at two anatomic locations in trauma patients. Injury. 2013;44(9):1183-1185.Google Scholar
21. Yamagiwa, T, Morita, S, Yamamoto, R, Seki, T, Sugimoto, K, Inokuchi, S. Determination of the appropriate catheter length for needle thoracostomy by using computed tomography scans of trauma patients in Japan. Injury. 2012;43(1):42-45.Google Scholar
22. Zengerink, I, Brink, PR, Laupland, KB, Raber, EL, Zygun, D, Kortbeek, JB. Needle thoracostomy in the treatment of a tension pneumothorax in trauma patients: what size needle? J Trauma. 2008;64(1):111-114.Google ScholarPubMed
23. Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, Group, P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-269, W64.Google Scholar
24. American Academy of Pediatrics, American College of Emergency Physicians, American College of Surgeons Committee on Trauma, Emergency Medical Services for Children, Emergency Nurses Association, National Association of EMS Physicians, National Association of State EMS Officials. Equipment for ground ambulances. Prehosp Emerg Care. 2014;18(1):92-97.Google Scholar
25. Centers for Disease Control and Prevention. Obesity--United States, 1999-2010. MMWR. 2013;62(Suppl 3):120-128.Google Scholar
26. World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Geneva, Switzerland: WHO; 2000.Google Scholar
27. Butler, KL, Best, IM, Weaver, WL, Bumpers, HL. Pulmonary artery injury and cardiac tamponade after needle decompression of a suspected tension pneumothorax. J Trauma. 2003;54(3):610-611.Google Scholar
28. Rawlins, R, Brown, KM, Carr, CS, Cameron, CR. Life threatening haemorrhage after anterior needle aspiration of pneumothoraces. A role for lateral needle aspiration in emergency decompression of spontaneous pneumothorax. Emerg Med J. 2003;20(4):383-384.CrossRefGoogle ScholarPubMed
29. Davis, DP, Pettit, K, Rom, CD, et al. The safety and efficacy of prehospital needle and tube thoracostomy by aeromedical personnel. Prehosp Emerg Care. 2005;9(2):191-197.Google Scholar
30. Heng, K, Bystrzycki, A, Fitzgerald, M, et al. Complications of intercostal catheter insertion using EMST techniques for chest trauma. ANZ J Surg. 2004;74(6):420-423.CrossRefGoogle ScholarPubMed