Evaluation of a novel thoracic entry device versus needle decompression in a tension pneumothorax swine model.

Abstract

INTRODUCTION: Tension pneumothorax (tPTX) remains a major cause of preventable death in trauma. Needle decompression (ND) has up to a 60% failure rate. METHODS: Post-mortem swine used. Interventions were randomized to 14G-needle decompression (ND, n&#x202f;=&#x202f;25), bladed trocar with 36Fr cannula (BTW, n&#x202f;=&#x202f;16), bladed trocar alone (BTWO, n&#x202f;=&#x202f;16) and surgical thoracostomy (ST&#x202f;=&#x202f;11). Simulated tPTX was created to a pressure(p) of 20&#x202f;mmHg. RESULTS: Success (p&#x202f;<&#x202f;5&#x202f;mmHg by 120&#x202f;s) was seen in 41 of 68 (60%) interventions. BTW and BTWO were consistently more successful than ND with success rates of 88% versus 48% in ND (p&#x202f;<&#x202f;.001). In successful deployments, ND was slower to reach p&#x202f;<&#x202f;5&#x202f;mmHg, average of 82s versus 26s and 28s for BTW and BTWO respectively (p&#x202f;<&#x202f;.001). Time to implement procedure was faster for ND with an average of 3.6s versus 16.9s and 15.3s in the BTW and BTWO (p&#x202f;<&#x202f;.001). Final pressure was significantly less in BTW and BTWO at 1.7&#x202f;mmHg versus 7&#x202f;mmHg in ND animals (p&#x202f;<&#x202f;.001). CONCLUSION: Bladed trocars can safely and effectively tPTX with a significantly higher success rates than needle decompression.