Video-tube thoracostomy in trauma resuscitation: A pilot study. Issue 1 (January 2019)

• Record Type: Journal Article
• Authors: Finnegan, P.; Fitzgerald, M.; Smit, D.; Martin, K.; Mathew, J.; Varma, D.; Lim, A.; Scott, S.; Williams, K.; Kim, Y.; Mitra, B.
• Is Part Of: Injury. Volume 50:Issue 1(2019)
• Page Start: 90
• Page End: 95
• Publication Date: 2019-01
• Subjects: Videoscope -- Trauma -- Injuries -- Tube thoracostomy -- Intercostal catheter; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2018.08.007
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Thoracic injuries are responsible for over 35% of trauma deaths. Tube Thoracostomy is the current best practice for treatment of haemo-pneumothorax. Failure of Tube Thoracostomy is associated with substantial mortality and morbidity. Failure of Tube Thoracostomy may occur due to tube malposition when guided by hand. Video- Tube Thoracostomy uses real-time video feedback to prevent tube malposition. Abstract: Background: Complications related to incorrect positioning of tube thoracostomy (TT) have been reported to be as high as 30%. The aim of this study was to assess the feasibility of flexible videoscope guided placement of a pre-loaded chest tube, permitting direct intrapleural visualization and placement (Video-Tube Thoracostomy [V-TT]). Methods: A prospective, single centre, phase 1 pilot study with a parallel control group was undertaken. The population studied were adult thoracic trauma patients requiring emergency TT who were haemodynamically stable. The intervention performed was VTT. Patients in the control group underwent conventional TT. The primary outcome was tube position as defined by a consultant radiologist's interpretation of chest x-ray (CXR) or CT. The trial was registered with ANZCTR.org.au (ACTRN: 12, 615, 000, 870, 550). Results: There were 37 patients enrolled in the study - 12 patients allocated to the VTT intervention group and 25 patients allocated to conventional TT. Mean age of participants was 48 years (SD 15) in intervention group and 46 years (SD 15) years in the control group. In the VTT group all patients were male; the indications were pneumothorax (83%), haemothorax (8%) and haemopneumothorax (8%). The median injury severity score was 23 (16–28). There were 1 positional and 1 insertional complications. In the control group 72% of patients were male, the indications were pneumothorax (56%), haemothorax (4%) and haemopneumothorax (40%). The median injury severity score was 24 (14–36). There were 8 (32%) positional complications and no insertional complications. Conclusion: V-TT was demonstrated to be a feasible alternative to conventional thoracostomy and merits further investigation.