Fenestrated Catheters are Superior to Non-Fenestrated Needle Thoracostomy Catheters in a Cadaveric Tension Pneumothorax Model.

Abstract

Objectives: Tension pneumothorax (tPTX) is the third leading cause of preventable death on the battlefield. Needle thoracostomy (NT) is the standard prehospital treatment; however, the optimal catheter characteristics are unknown. This study compares the efficacy of NT using 3.25-inch 14ga and 3.25-inch 10ga, non-fenestrated and fenestrated catheters in a tPTX model.

Methods: This was a non-randomized, non-blinded study using fresh, unembalmed, never frozen, human cadavers. Tension pneumothorax was induced by air insufflation to 15 mmHg through a 10ga pleural catheter. The tPTX was then released through the test devices (14ga non-fenestrated, 14ga fenestrated, 10ga non-fenestrated, 10ga fenestrated) placed at either the 5th intercostal space (ICS) anterior-axillary line or 2nd ICS mid-clavicular line. The change in intrathoracic pressure and the time to lowest pressure were recorded. The primary end point was the successful relief of tPTX which was defined as a decrease in pleural pressure to <4 mmHg. The needle thoracostomy catheter was capped, tPTX was reestablished, and the process was repeated for the remaining three locations.

Results: The protocol was performed on twelve cadavers with two NT procedures performed on each side of the chest. Non-fenestrated catheters were successful in 7/16 (44%) attempts while fenestrated catheters were successful in 27/32 (84%) attempts, p < 0.01. Median time to minimum pressure was 33.0 s (IQR 19.1, 46.3) seconds for non-fenestrated and 30.9 s (IQR 19.8, 37.8) seconds for fenestrated catheters, p = 0.96. The median time to minimum pressure was 36.0 s (IQR 26.1, 44.8) for 14ga catheters and 21.2 s (IQR 10.9, 35.5) for 10ga catheters, p = 0.01.

Conclusions: Fenestrated NT catheters were superior to non-fenestrated catheters in the management of tPTX in this cadaver model. There is reasonable expectation of similar performance in real-world use. The selection of 14ga versus 10ga catheters is less important than inclusion of fenestrations for rapid relief of tension physiology.