10-Gauge versus 14-Gauge Fenestrated Needle/Catheter Units for Decompression of Tension Pneumothorax in Cadaveric Model.

BACKGROUND

Needle decompression (NDC) is the primary treatment of tension pneumothorax (tPTX) in prehospital settings. This study compared 10-gauge (10ga) and 14-gauge (14ga) fenestrated needle/catheter units for NDC. We hypoth-esized 10ga needle/catheter units would demonstrate higher tPTX decompression rates compared to 14ga needle/catheter units.

METHODS

A non-randomized, non-blinded study was conducted using human cadavers with artificially induced tPTX (pleural pressure of 15mmHg). A 10ga or 14ga unit was in-serted into the 5th intercostal space, anterior axillary line, or the 2nd intercostal space, midclavicular line. Successful NDC was defined as a pressure decrease to less than 4mmHg.

RESULTS

In 116 NDC attempts, there was no difference in the success rate of NDC between 10ga versus 14ga units (91.1% vs. 91.1%, P=1.0). The median time to decompression of tPTX was faster using 10ga at 22.0s (IQR 14.5-42.0) vs. 14ga at 39.8 seconds (IQR 30.3-57.6, P<.001). No difference was found in time to successful decompression between AAL and MCL sites (36.0s [IQR 21.7-51.7] vs. 30.4s [IQR 18.7-49.5], P=.46). The 10ga needle/catheter units achieved an audible release of air with the needle still in place during successful NDC more frequently compared to the 14ga units (65.3% vs. 34.7%; P=.034). Con-clusion: NDC with 10ga fenestrated needle/catheter units was similarly effective, but significantly faster than 14ga units for tPTX in a cadaveric model. A safe, depth-limiting technique was over 90% effective across all NDC sites.