EAST 2014: Trochar vs Needle (vs Finger Thoracostomy) For Tension Pneumothorax?

I’ve been involved in a number of debates regarding the best way to decompress the chest if there is a suspected tension pneumothorax. Some are proponents of the needle (I used to be one). Some believe that finger thoracostomy is better because it does not necessarily create a simple pneumothorax if you were wrong (I’ve come around to this one).

Surgeons at Madigan Army Medical Center in Washington State tried something a little different. They experimented with placing a 5mm laparoscopy port for treatment of induced tension pneumo in a large animal model (swine) to see how safe it was.

Here are the factoids:

  • Tension pneumo (TPTX) and/or pulseless electrical activity (PEA) was induced about 30 times each in 5 adult swine. TPTX was defined as a measured 50% decrease in cardiac output.
  • Placement of a 5mm laparoscopy trochar immediately relieved the abnormal physiology in 100% of TPTX cases
  • Trochar placement restored perfusion within 30 seconds in all PEA cases
  • No trochar induced injury to heart or lung was identified in any animal at necropsy
  • The authors compared these results to older needle decompression literature which showed only 40-70% success rates

Bottom line: Using a laparoscopy port to quickly relieve tension pneumo or PEA from TPTX looks like an option. It’s fast, reliable, and safe. Surgeons place these all the time in the OR, and they are designed to safely push skin and subq layers aside, not harming the viscera. However, it does suffer the same drawback as the needle: it will create a simple pneumothorax. And it will probably do so 100% of the time, guaranteeing the need for a chest tube. Furthermore, these are expensive toys to stock in an ED for only occasional use. Interesting, but I would not recommend.

Reference: 5mm trochars for the treatment of tension pneumothorax: a superior alternative to needle decompression. EAST 2014, poster abstract #1.

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