Dewar Zachary E, Ko Stephanie, Rogers Cameron, Oropallo Alexis, Augustine Andrew, Pamula Ankitha, Berry Christopher L
Department of Emergency Medicine, Guthrie Robert Packer Hospital, One Guthrie Square, Sayre, PA, 18840, USA.
Wilkes University, 84 West South Street, Wilkes-Barre, PA, 18766, USA.
Ultrasound J. 2022 Jun 13;14(1):23. doi: 10.1186/s13089-022-00270-w.
Simulated needle thoracostomy (NT) using ultrasound may reduce potential injury, increase accuracy, and be as rapid to perform as the traditional landmark technique following a brief educational session. Our objective was to determine if the use of an educational session demonstrating the use of handheld ultrasound to Emergency Medical Services (EMS) staff to facilitate NT was both feasible, and an effective way of increasing the safety and efficacy of this procedure for rural EMS providers.
A pre/post-educational intervention on a convenience sample of rural North American EMS paramedics and nurses. Measurement of location and estimated depth of placement of needle thoracostomy with traditional landmark technique was completed and then repeated using handheld ultrasound following a training session on thoracic ultrasound and correct placement of NT.
A total of 30 EMS practitioners participated. Seven were female (23.3%). There was a higher frequency of dangerous structures underlying the chosen location with the landmark technique 9/60 (15%) compared to the ultrasound technique 1/60 (1.7%) (p = 0.08). Mean time-to-site-selection for the landmark technique was shorter than the ultrasound technique at 10.7 s (range 3.35-45 s) vs. 19.9 s (range 7.8-50 s), respectively (p < 0.001). There was a lower proportion of correct location selection for the landmark technique 40/60 (66.7%) when compared to the ultrasound technique 51/60 (85%) (p = 0.019). With ultrasound, there was less variance between the estimated and measured depth of the pleural space with a mean difference of 0.033 cm (range 0-0.5 cm) when ultrasound was used as compared to a mean difference of 1.0375 cm (range 0-6 cm) for the landmark technique (95% CI for the difference 0.73-1.27 cm; p < 0.001).
Teaching ultrasound NT was feasible in our cohort. While time-to-site-selection for ultrasound-guided NT took longer than the landmark technique, it increased safe and accurate simulated NT placement with fewer identified potential iatrogenic injuries.
在经过简短培训后，使用超声模拟进行针胸造口术（NT）可能会减少潜在损伤、提高准确性，并且与传统的体表定位技术操作速度相当。我们的目的是确定向紧急医疗服务（EMS）人员演示如何使用手持超声辅助进行NT的培训是否可行，以及是否能有效提高农村EMS提供者进行该操作的安全性和有效性。
对北美农村地区的EMS护理人员和护士进行便利抽样，进行培训前/后的干预。先用传统体表定位技术测量针胸造口术的穿刺位置和估计穿刺深度，然后在进行胸部超声和正确NT放置培训后，使用手持超声重复测量。
共有30名EMS从业者参与。其中7名女性（23.3%）。与超声技术相比，体表定位技术所选位置下方危险结构出现的频率更高，分别为9/60（15%）和1/60（1.7%）（p = 0.08）。体表定位技术的平均选点时间短于超声技术，分别为10.7秒（范围3.35 - 45秒）和19.9秒（范围7.8 - 50秒）（p < 0.001）。与超声技术相比，体表定位技术的正确选点比例较低，分别为40/60（66.7%）和51/60（85%）（p = 0.019）。使用超声时，胸膜腔估计深度与测量深度之间的差异较小，平均差异为0.033厘米（范围0 - 0.5厘米），而体表定位技术的平均差异为1.0375厘米（范围0 - 6厘米）（差异的95%置信区间为0.73 - 1.27厘米；p < 0.001）。
在我们的队列中，教授超声引导下的NT是可行的。虽然超声引导下的NT选点时间比体表定位技术长，但它增加了模拟NT放置的安全性和准确性，且识别出的潜在医源性损伤更少。
