System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Ahead of print

PubMed: 42782255 DOI: 10.1080/10903127.2026.2739424

Prehospital Minithoracostomy versus Chest Drainage for Emergency Pleural Decompression in Major Trauma.

Prehosp Emerg Care

Authors: Serena Tomasino, Daniele Orso, Maria Grandesso, Carlo Pegani, Annarita Tullio, Gabriele Simeoni, Chiara Molinari, Samantha Saffer, Sabrina Fantin, Alessio Sappada, Alessandra Spasiano, Giorgio Della Rocca

Affiliations

  • Department of Anesthesia and Intensive Care Medicine, "Santa Maria della Misericordia", Udine University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy.
  • Department of Anesthesia and Intensive Care Medicine, Azienda Sanitaria Friuli Occidentale, Pordenone, Italy.
  • Department of Perioperative, Intensive Care and Emergency Medicine, Cattinara University Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.
  • Department of Medicine, University of Udine, Udine, Italy.
  • Department of Anesthesia and Intensive Care Medicine, "Santa Maria della Misericordia", Udine University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy. Regional Emergency Medical Operations Structure, Azienda Regionale di Coordinamento per la Salute, Udine, Italy.

Abstract

OBJECTIVES

Prehospital pleural decompression is life-saving in patients with suspected tension pneumothorax or other life-threatening thoracic pressure pathology after major trauma. Although prehospital minithoracostomy (PHMT) is increasingly adopted by physician-led helicopter emergency medical services (HEMS), comparative evidence with prehospital chest drainage (PHCD) remains limited.

METHODS

We conducted a retrospective observational cohort study of consecutive adult trauma patients undergoing prehospital pleural decompression within a physician-led HEMS between January 2018 and December 2024, managed with PHMT or PHCD according to clinical judgment. The primary outcome, scene time, was analyzed using Bayesian robust Student-t regression; recorded complications and survival were analyzed using Bayesian beta-binomial models, with posterior risk differences and credible intervals.

RESULTS

Ninety-four patients were included (66 PHMT; 28 PHCD). After excluding two implausible zero-minute scene-time records, the posterior median difference in scene time was -5.9 min (95% credible interval [CrI], -13.8 to 1.7; 94.0% probability PHMT was shorter). Complication status was evaluable in 50/66 PHMT and 10/28 PHCD patients. Recorded complications occurred in 0/50 evaluable PHMT and 6/10 evaluable PHCD patients (risk difference -58.7 percentage points, 95% CrI -83.9 to -29.3; probability >99.9% that recorded complications were less frequent with PHMT). Prehospital survival was lower with PHMT, reflecting greater baseline severity, whereas no clear differences were observed at 1, 30, or 90 days.

CONCLUSIONS

Prehospital minithoracostomy was not associated with longer scene time and was associated with fewer recorded complications than PHCD. Because allocation was nonrandomized, complication ascertainment differed between procedures, and few events occurred, these findings are hypothesis-generating rather than evidence of comparative safety. Prospective multicenter studies with standardized indications and systematic outcome assessment are warranted.

MeSH

Drainage, Emergencies, Probability, Decompression, Physicians, Wounds And Injuries