Modified Veress needle decompression of tension pneumothorax

A randomized crossover animal study

Dafney Lubin, Andrew L. Tang, Randall S. Friese, Matthew Martin, D. J. Green, Trevor Jones, Russell R. Means, Rashna Ginwalla, Terence OKeeffe, Bellal A. Joseph, Julie L. Wynne, Narong Kulvatunyou, Gary Vercruysse, Lynn Gries, Peter Rhee

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The current prehospital standard of care using a large bore intravenous catheter for tension pneumothorax (tPTX) decompression is associated with a high failure rate. We developed a modified Veress needle (mVN) for this condition. The purpose of this study was to evaluate the effectiveness and safety of the mVN as compared with a 14-gauge needle thoracostomy (NT) in a swine tPTX model. METHODS: tPTX was created in 16 adult swine via thoracic CO2 insufflation to 15 mm Hg. After tension physiology was achieved, defined as a 50% reduction of cardiac output, the swine were randomized to undergo either mVN or NT decompression. Failure to restore 80% baseline systolic blood pressure within 5 minutes resulted in crossover to the alternate device. The success rate of each device, death, and need for crossover were analyzed using W2. RESULTS: Forty-three tension eventswere created in 16 swine (24mVN, 19 NT) at 15mmHg of intrathoracic pressure with a mean CO2 volume of 3.8 L. tPTX resulted in a 48% decline of systolic blood pressure from baseline and 73% decline of cardiac output, and 42% had equalization of central venous pressure with pulmonary capillary wedge pressure. All tension events randomized to mVN were successfully rescued within a mean (SD) of 70 (86) seconds. NT resulted in four successful decompressions (21%) within a mean (SD) of 157 (96) seconds. Four swine (21%) died within 5 minutes of NT decompression. The persistent tension events where the swine survived past 5 minutes (11 of 19 NTs) underwent crossover mVN decompression, yielding 100% rescue. Neither the mVN nor the NT was associated with inadvertent injuries to the viscera. CONCLUSION: Thoracic insufflation produced a reliable and highly reproducible model of tPTX. The mVN is vastly superior to NT for effective and safe tPTX decompression and physiologic recovery. Further research should be invested in the mVN for device refinement and replacement of NT in the field.

Original languageEnglish (US)
Pages (from-to)1071-1075
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume75
Issue number6
DOIs
StatePublished - Dec 1 2013
Externally publishedYes

Fingerprint

Thoracostomy
Pneumothorax
Decompression
Cross-Over Studies
Needles
Swine
Blood Pressure
Insufflation
Cardiac Output
Equipment and Supplies
Thorax
Central Venous Pressure
Pulmonary Wedge Pressure
Viscera
Standard of Care
Catheters
Safety
Pressure

Keywords

  • Needle thoracostomy
  • Swine
  • Tension pneumothorax
  • Trauma
  • Veress needle

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Modified Veress needle decompression of tension pneumothorax : A randomized crossover animal study. / Lubin, Dafney; Tang, Andrew L.; Friese, Randall S.; Martin, Matthew; Green, D. J.; Jones, Trevor; Means, Russell R.; Ginwalla, Rashna; OKeeffe, Terence; Joseph, Bellal A.; Wynne, Julie L.; Kulvatunyou, Narong; Vercruysse, Gary; Gries, Lynn; Rhee, Peter.

In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 6, 01.12.2013, p. 1071-1075.

Research output: Contribution to journalArticle

Lubin, D, Tang, AL, Friese, RS, Martin, M, Green, DJ, Jones, T, Means, RR, Ginwalla, R, OKeeffe, T, Joseph, BA, Wynne, JL, Kulvatunyou, N, Vercruysse, G, Gries, L & Rhee, P 2013, 'Modified Veress needle decompression of tension pneumothorax: A randomized crossover animal study', Journal of Trauma and Acute Care Surgery, vol. 75, no. 6, pp. 1071-1075. https://doi.org/10.1097/TA.0b013e318299563d
Lubin, Dafney ; Tang, Andrew L. ; Friese, Randall S. ; Martin, Matthew ; Green, D. J. ; Jones, Trevor ; Means, Russell R. ; Ginwalla, Rashna ; OKeeffe, Terence ; Joseph, Bellal A. ; Wynne, Julie L. ; Kulvatunyou, Narong ; Vercruysse, Gary ; Gries, Lynn ; Rhee, Peter. / Modified Veress needle decompression of tension pneumothorax : A randomized crossover animal study. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 75, No. 6. pp. 1071-1075.
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abstract = "BACKGROUND: The current prehospital standard of care using a large bore intravenous catheter for tension pneumothorax (tPTX) decompression is associated with a high failure rate. We developed a modified Veress needle (mVN) for this condition. The purpose of this study was to evaluate the effectiveness and safety of the mVN as compared with a 14-gauge needle thoracostomy (NT) in a swine tPTX model. METHODS: tPTX was created in 16 adult swine via thoracic CO2 insufflation to 15 mm Hg. After tension physiology was achieved, defined as a 50{\%} reduction of cardiac output, the swine were randomized to undergo either mVN or NT decompression. Failure to restore 80{\%} baseline systolic blood pressure within 5 minutes resulted in crossover to the alternate device. The success rate of each device, death, and need for crossover were analyzed using W2. RESULTS: Forty-three tension eventswere created in 16 swine (24mVN, 19 NT) at 15mmHg of intrathoracic pressure with a mean CO2 volume of 3.8 L. tPTX resulted in a 48{\%} decline of systolic blood pressure from baseline and 73{\%} decline of cardiac output, and 42{\%} had equalization of central venous pressure with pulmonary capillary wedge pressure. All tension events randomized to mVN were successfully rescued within a mean (SD) of 70 (86) seconds. NT resulted in four successful decompressions (21{\%}) within a mean (SD) of 157 (96) seconds. Four swine (21{\%}) died within 5 minutes of NT decompression. The persistent tension events where the swine survived past 5 minutes (11 of 19 NTs) underwent crossover mVN decompression, yielding 100{\%} rescue. Neither the mVN nor the NT was associated with inadvertent injuries to the viscera. CONCLUSION: Thoracic insufflation produced a reliable and highly reproducible model of tPTX. The mVN is vastly superior to NT for effective and safe tPTX decompression and physiologic recovery. Further research should be invested in the mVN for device refinement and replacement of NT in the field.",
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T2 - A randomized crossover animal study

AU - Lubin, Dafney

AU - Tang, Andrew L.

AU - Friese, Randall S.

AU - Martin, Matthew

AU - Green, D. J.

AU - Jones, Trevor

AU - Means, Russell R.

AU - Ginwalla, Rashna

AU - OKeeffe, Terence

AU - Joseph, Bellal A.

AU - Wynne, Julie L.

AU - Kulvatunyou, Narong

AU - Vercruysse, Gary

AU - Gries, Lynn

AU - Rhee, Peter

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N2 - BACKGROUND: The current prehospital standard of care using a large bore intravenous catheter for tension pneumothorax (tPTX) decompression is associated with a high failure rate. We developed a modified Veress needle (mVN) for this condition. The purpose of this study was to evaluate the effectiveness and safety of the mVN as compared with a 14-gauge needle thoracostomy (NT) in a swine tPTX model. METHODS: tPTX was created in 16 adult swine via thoracic CO2 insufflation to 15 mm Hg. After tension physiology was achieved, defined as a 50% reduction of cardiac output, the swine were randomized to undergo either mVN or NT decompression. Failure to restore 80% baseline systolic blood pressure within 5 minutes resulted in crossover to the alternate device. The success rate of each device, death, and need for crossover were analyzed using W2. RESULTS: Forty-three tension eventswere created in 16 swine (24mVN, 19 NT) at 15mmHg of intrathoracic pressure with a mean CO2 volume of 3.8 L. tPTX resulted in a 48% decline of systolic blood pressure from baseline and 73% decline of cardiac output, and 42% had equalization of central venous pressure with pulmonary capillary wedge pressure. All tension events randomized to mVN were successfully rescued within a mean (SD) of 70 (86) seconds. NT resulted in four successful decompressions (21%) within a mean (SD) of 157 (96) seconds. Four swine (21%) died within 5 minutes of NT decompression. The persistent tension events where the swine survived past 5 minutes (11 of 19 NTs) underwent crossover mVN decompression, yielding 100% rescue. Neither the mVN nor the NT was associated with inadvertent injuries to the viscera. CONCLUSION: Thoracic insufflation produced a reliable and highly reproducible model of tPTX. The mVN is vastly superior to NT for effective and safe tPTX decompression and physiologic recovery. Further research should be invested in the mVN for device refinement and replacement of NT in the field.

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KW - Needle thoracostomy

KW - Swine

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