Décompression pleurale: Dur, dur...

Failure rate of prehospital chest decompression after severe thoracic trauma.

Kaserer A. et Al Am J Emerg Med. 2016 Nov 30. pii: S0735-6757(16)30892-0

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Une publication qui émane de nos collègues suisses et qui interpelle quelque peu. La décompression thoracique apparat être un geste dont la maîtrise est largement insuffisante y compris quand elle est réalisée au sein d'un système mature. Une raison de plus pour s'intéresser à la maîtrise effective des gestes censés participer à la mise en condition de survie des blessés. On rappelle l'intérêt de la thoracostomie au doigt (1), doigt dont la longueur est en général suffisante pour entrer dans un thorax.

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INTRODUCTION:

Chest decompression can be performed by different techniques, like needle thoracocentesis (NT), lateral thoracostomy (LT), or tube thoracostomy (TT). The aim of this study was to report the incidence of prehospital chest decompression and to analyse the effectiveness of these techniques.

MATERIAL AND METHODS:

In this retrospective case series study, all medical records of adult trauma patients undergoing prehospital chest decompression and admitted to the resuscitation area of a level-1 trauma center between 2009 and 2015 were reviewed and analysed. Only descriptive statistics were applied.

RESULTS:

In a 6-year period 24 of 2261 (1.1%) trauma patients had prehospital chest decompression. Seventeen patients had NT, six patients TT, one patient NT as well as TT, and no patients had LT. Prehospital successful release of a tension pneumothorax was reported by the paramedics in 83% (5/6) with TT, whereas NT was effective in 18% only (3/17). In five CT scans all thoracocentesis needles were either removed or extrapleural, one patient had a tension pneumothorax, and two patients had no pneumothorax. No NT or TT related complications were reported during hospitalization.

CONCLUSION:

Prehospital NT or TT is infrequently attempted in trauma patients. Especially NT is associated with a high failure rate of more than 80%, potentially due to an inadequate ratio between chest wall thickness and catheter length as previously published as well as a possible different pathophysiological cause of respiratory distress. Therefore, TT may be considered already in the prehospital setting to retain sufficient pleural decompression upon admission.