Decompress that Cadaver - STAT

Short Attention Span Summary

Decompress that cadaver - STAT
The 2nd intercostal space (ICS) midclavicular line (MCL) chest wall was slightly thinner (2.5 cm) than the 5th ICS mid-axillary line (MAL), 2.9 cm.  There was no statistical difference in success rate based on location, though the trend favored the 2nd ICS.  Overall failure rate to enter the pleural space was 15%, despite using a 5 cm long catheter.  Cadavers < 72 kg had 100% success in entering the pleural space.

Spoon Feed: Based on this cadaver study, a 5cm catheter should be highly successful for needle decompression at either the 2nd ICS MCL or 5th ICS MAL.  Hopefully this will reduce the incidence of cadaver formation from tension PTX.

By the way, it's inauguration day (in the U.S).  Over half of US voters are pretty bummed and fearful of what lies ahead.  Some are optimistic.  Some are clueless.  No matter our political views, we share a common goal - the best care for our patients.  And that brings us together.  I'm just glad to be on the same team as so many talented emergency clinicians from around the world.  Fun fact - there is one reason to celebrate today.  It's also my brother's birthday!


Abstract

Am J Emerg Med. 2016 Dec;34(12):2310-2314. doi: 10.1016/j.ajem.2016.08.038. Epub 2016 Aug 20.

Determination of the chest wall thicknesses and needle thoracostomy success rates at second and fifth intercostal spaces: a cadaver-based study.

Ozen C1, Akoglu H2, Ozdemirel RO3, Omeroglu E4, Ozpolat CU5, Onur O6, Buyuk Y7, Denizbasi A8.

Author information:

1Department of Emergency Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey. Electronic address: canozenmd@gmail.com.

2Department of Emergency Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey. Electronic address: drhaldun@gmail.com.

3Mortuary Department of Council of Forensic Medicine of Ministry of Justice in Istanbul, Turkey. Electronic address: rifatozdemirel@gmail.com.

4Mortuary Department of Council of Forensic Medicine of Ministry of Justice in Istanbul, Turkey. Electronic address: elif_omeroglu@hotmail.com.

5Department of Emergency Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey. Electronic address: cumed17@gmail.com.

6Department of Emergency Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey. Electronic address: ozgeozberk@gmail.com.

7Mortuary Department of Council of Forensic Medicine of Ministry of Justice in Istanbul, Turkey. Electronic address: doctorbuyuk@gmail.com.

8Department of Emergency Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey. Electronic address: denizbasi@gmail.com.

Abstract

INTRODUCTION:

The purposes of this study were to measure the chest wall thicknesses (CWTs) at second intercostal space (ICS) mid-clavicular line (MCL) and fifth ICS MAL directly, and compare the actual success rates of needle thoracostomies (NTs) by inserting a 5-cm-long syringe needle. Predictive values of weight, body mass index (BMI) and CWT were also analyzed.

MATERIALS AND METHODS:

This study included 199 measurements of 50 adult fresh cadavers from both hemithoraces. Five-centimeter-long syringe needles were inserted and secured. Penetration into the pleural cavity was assessed, and CWTs at 4 locations were measured. Achieved power of this study for the primary aim of CWT comparison from 2nd and 5th ICSs was .94.

RESULTS:

Overall mean CWTs at 2nd ICS MCL and 5th ICS MAL were measured as 2.46 ± 0.78 and 2.89 ± 1.09, respectively, and 5th ICS MAL was found to be statistically thicker (P = .002). The success rate of NT at 2nd ICS MCL was 87% (95% CI, 80-94), and that at 5th ICS MAL was 78% (95% CI, 70-86; P = .3570). Only 6 (17.1%) of 35 failed NTs had a CWT greater than 5-cm. Needle thoracostomy has failed in 29 (14.9%) of 194 locations, despite a CWT less than 5-cm. Below a weight of 72 kg, BMI of 23 kg/m2, or CWT of 2.4 cm, all NTs were successful.

DISCUSSION AND CONCLUSIONS:

In this report, we present the largest cadaver-based cohort to date to the best of our knowledge, and we observed a statistically nonsignificant 9% more NT success rate at 2nd ICS at a power of 88% and statistically significant more success rate in males at 5th ICS was (47.7%). We also observed thinner CWTs and higher success rates than previous imaging-based studies. A BMI of 23 kg/m2 or less and weight of 72 kg or less seem to accurately rule-out NT failure in cadavers, and they seem to be better predictors at the bedside.

Copyright © 2016 Elsevier Inc. All rights reserved.

PMID: 27609120 [PubMed - in process]