Evaluation of Monaldi’s approach with regard to needle decompression of the tension pneumothorax—A cadaver study |
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| Institution: | 1. Medical University of Graz, Department of Orthopedics and Trauma Surgery, Austria;2. AUVA Trauma Hospital Graz, Austria;3. University of Graz, Austria;4. State Hospital Hochsteiermark/Leoben, Department for Surgery, Austria;5. State Hospital Judenburg-Knittelfeld, Austria;6. Institute of Anatomy, Austria;1. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States;3. Harborview Injury Prevention and Research Center, Seattle, WA, United States;4. Department of Epidemiology, University of Washington, Seattle, WA, United States;5. Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, United States;1. University of Washington, Seattle, USA;2. Universidad Peruana Cayetano Heredia, Lima, Peru;3. Universidad del Azuay, Cuenca, Ecuador;4. Hospital Nacional Guillermo Almenara, Lima, Peru;5. Clinica Foianini, Santa Cruz, Bolivia;6. Neuroscience Institute, Neurotrauma Group, El Bosque University, Bogotá, Colombia;1. Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia;2. School of Surgery, The University of Western Australia, Perth, Australia;1. Department of Vascular and Thoracic Surgery, Sainte-Anne Military Teaching Hospital, Toulon, 83 800, France;2. Strasbourg Armed Forces Medical Center, Strasbourg, 67000, France;1. Trauma Intensive and Critical Care Unit, Department of Anesthesiology and Critical Care, Lapeyronie Hospital, Montpellier I University, Montpellier, France;2. Institut National de la Santé et de la Recherche Médicale, Equipe Inserm U1046, 34295 Montpellier, France;1. Division of Pediatric Surgery, University of Tennessee, Health Science Center, Le Bonheur Children’s Hospital, 49 North Dunlap, Second Floor, Memphis, TN 38105, USA;2. Department of General Surgery, University of Tennessee, Health Science Center, 920 Madison Ave., Memphis, TN 38103, United States |
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| Abstract: | BackgroundAlthough needle decompression of tension pneumothorax through the second intercostal space in the midclavicular line (Monaldi’s approach) is a life-saving procedure, severe complications have been reported after its implementation. We evaluated the procedure by comparing how it was performed on cadavers by study participants with different training levels.MethodsSix participants including one thoracic surgeon performed bilateral thoracic drainage after Monaldi on 82 torsos. After the thoraces were opened, the distances from the internal thoracic artery (A), the site of the puncture (B) and the midclavicular line (C) were measured bilaterally with reference to the median of the sternum. Further, it was determined whether the participants had correctly identified the second intercostal space. The differences between B-A and C-B were analysed.ResultsThe needle was placed in the second intercostal space in 136 hemithoraces (83%). The thoracic surgeon showed a hit rate of 0% laceration of adjacent vessels. All the other participants had hit rates between 10% and 15%. The interval B-A ranged from 2.88 to 5.06 cm in right and from 3.00 to 5.00 cm in left hemithoraces. The distance C-B lay between 1.03 cm and 1.87 cm (right side), and 0.84 cm and 2.02 cm (left side).ConclusionIn our collective, the main problem was failure to assess correctly the lateral extension of the clavicle. If this fact is emphasized during training, Monaldi’s approach is a safe method for needle decompression of pneumothorax. |
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| Keywords: | Tension pneumothorax Needle decompression Monaldi’s approach |
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