A Matched Cohort Study of Open Thoracostomies Performed by Ground Medics

Alison Smith, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
Angelo Ciaraglia, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
Benjamin Axtman, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
CJ Winckler, Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
David Wampler, Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
Maxwell Braverman, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
Patrick C. Shahan, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
Rachelle Babbitt Jonas, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
Michael Shiels, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
Brian Eastridge, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
Ronald Stewart, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
Susannah Nicholson, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
Donald H. Jenkins, Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA.

Document Type

Article

Abstract

Background: Tension pneumothorax resulting from chest trauma is a rapidly fatal condition that requires prompt treatment. Prehospital open thoracostomy (POT) is a potentially lifesaving intervention that can be performed in the field to treat tension pneumothorax. However, the results from POT performed by ground EMS providers have not been well-studied. The objective of this study was to compare outcomes for patients with chest trauma who underwent POT performed by ground EMS providers with a matched cohort who did not undergo this procedure in the field.

Methods: A retrospective chart review of consecutive adult patients presenting to a Level I trauma center with chest trauma were analyzed from 2017-2020. Outcomes were compared to a patient cohort who did not undergo POT matched by severity of injury and prehospital CPR.

Results: A total of 14 POT patients were identified. Majority of POT were bilateral (n=11/14, 78.6%) and all of these patients (n=14/14) had prehospital cardiac arrest. Return of spontaneous circulation was obtained in 2 patients with penetrating injuries (14.3%). There was no difference in total and scene EMS time compared to the matched cohort without POT (p>0.05).

Conclusions: This study demonstrated that open thoracostomies could be performed by ground EMS units without increasing prehospital time for severely injured trauma patients and greater achievement of ROSC. Larger, prospective, multi-institutional analyses are needed to further evaluate outcomes.

DOI

https://doi.org/10.56068/QMBV3502

Publication Date

Spring 4-3-2023

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