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

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.