Tension Pneumothorax During Traumatic Cardiac Arrest with Positive Pressure Ventilation
Clinical scenario
Tension pneumothorax is a reversible cause of traumatic cardiac arrest. When the patient is receiving positive pressure ventilation, trapped air or blood can rapidly accumulate, preventing return of spontaneous circulation. Prompt chest decompression is a critical intervention in this setting.
Why thoracostomy in this situation
In the context of positive pressure ventilation during traumatic cardiac arrest, bilateral thoracostomies are considered more effective than needle thoracocentesis and faster than inserting a chest tube, making them the preferred decompressive approach at this stage.
Treatment approach (partial overview)
The intervention involves bilateral finger thoracostomies targeting specific anatomical landmarks on both sides of the chest, using a combined instrument and manual technique to access the pleural space and confirm lung position.
The complete procedural steps, the specific landmarks used, the exact sequence, and considerations for repeated tension are covered in the full protocol →
Clinical goal
Successful decompression achieves release of any air or blood causing pneumo/haemothorax, removing the obstructive cause of cardiac arrest.
References
- To decompress the chest in a traumatic cardiac arrest, perform bilateral thoracostomies in the 5th intercostal space in the mid axillary lines.
- In the presence of positive pressure ventilation, thoracostomies are likely to be more effective than needle thoracocentesis and quicker than inserting a chest tube (see tension pneumothorax).
- Finger thoracostomy is the first stage of a standard open chest drain insertion, by making a hole with a scalpel and forceps and placing a finger into the thorax to feel for lung.
- This will allow release of any air or blood causing pneumo/haemothorax.
- The added benefit is the thoracostomy can be ‘re-fingered’ in the case of repeated tension.
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