Four years of pre-hospital simple thoracostomy performed by a physician-paramedic helicopter emergency medical service team: A description and review of practice

Abstract

Background Essex and Herts Air Ambulance Trust operate doctor-paramedic pre-hospital care teams. Simple thoracostomy is performed if an intubated patient requires pleural decompression. Reports of the use of this technique are uncommon in the literature. This study describes the use of pre-hospital thoracostomy over four years. Pre-hospital complications and effect on oxygen saturations were also noted. Methods A retrospective database review of all missions that occurred between 1 April 2010 and 31 March 2014. All patients undergoing this procedure were included. Results A total of 126 patients were identified. In 110 (87%) of the total number of patients, the procedure was bilateral making the total number of thoracostomies performed 236. The mechanism of injury was blunt trauma in 115 (91%) and penetrating trauma in 11 patients (9%). The primary indication was traumatic cardiac arrest or peri-arrest in 51 patients (40%), high risk of pneumothorax in a ventilated patient in 45 patients (36%), pneumothorax diagnosed prior to delivery of anaesthesia in 17 patients (13%), and unexplained hypoxia in a ventilated patient in 13 patients (10%). The mean pulse oximetry measurement at the time of arrival was 91.8% and 97.2% at the time of handover ( p=0.003). No immediate complications were recorded on the database. Conclusion We have described the regular use of the technique of simple thoracostomy in trauma patients attended by our air ambulance service. It is the largest case series to date of simple thoracostomy being used in the context of pre-hospital chest trauma.