Written by Michael Stocker
Performing emergency finger thoracostomy (EFT) improved oxygen saturation in patients presenting to helicopter emergency medical services (HEMS) with blunt chest trauma requiring intubation and suspected compensated obstructive shock.
Cut the tension before it develops?
Prehospital EFT is a proven intervention to address tension pneumothorax (PTX). Could there be advantages to performing prehospital EFT in otherwise stable trauma patients at risk of tension PTX before they decompensate?
This retrospective study performed in the Hungarian HEMS system included 114 hemodynamically stable adult patients with blunt chest trauma requiring on-scene intubation (ETT) and receiving EFT on one or both sides of the chest. HEMS providers were authorized to perform EFT if clinical suspicion for PTX or progression to tension PTX was high. The control (n=29) was patients receiving EFT without noticeable return of air or blood. Vital sign changes were tracked before and after procedures. Significant improvements in post-EFT SpO2 were noted (89.6% to 94.6%, p<0.001), though other vital signs did not show similar improvement. Few complications were attributable to EFT, but hospital follow-up data was meager. The absence of a control not receiving EFT limits the impact.
How does this change my practice?
While this is an interesting case series, the lack of robust patient-centered outcomes (e.g. mortality, complications) and generalizability to U.S. practice gives me pause. Hungarian HEMS protocol requires crews to land and egress for 360-degree access to the patient before performing EFT if necessary after take-off. In that context, preemptive EFT preflight may be justified; however, inflight procedures are the norm in my experience with U.S. HEMS. Additionally, physicians are a standard part of Hungarian HEMS crews, but rarely serve in this role in the US. EFT is not without significant risks, so an SpO2 bump in an otherwise hemodynamically stable patient is not enough to outweigh them in my mind. I’ll continue to reserve prehospital EFT for clear tension pathology and prioritize expediting transport to definitive care.
Source
Prehospital emergency finger thoracostomy in compensated obstructive shock: Benefits and outcomes. Injury. 2025 May;56(5):112331. doi: 10.1016/j.injury.2025.112331. Epub 2025 Apr 7. PMID: 40234110
