{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T02:09:05Z","timestamp":1789697345737,"version":"4.0.1"},"reference-count":16,"publisher":"Oxford University Press (OUP)","funder":[{"name":"AMEDD Advanced Medical Technologies Initiative"},{"name":"Telemedicine and Advanced Technologies Research Center"},{"name":"U.S. Army Medical Research and Material Command"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Tension pneumothorax is a common cause of preventable death in trauma. Needle decompression is the traditional first-line intervention but has high failure rates. We sought to evaluate the effectiveness and expedience of needle thoracostomy, surgical tube thoracostomy, and Reactor\u2122 thoracostomy \u2013 a novel spring-loaded trocar insertion device.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Yorkshire swine underwent controlled thoracic insufflation to create tension pneumothorax physiology for device comparison. Additional experiments were performed by increasing insufflation pressures to achieve pulseless electrical activity. Intervention was randomized to needle thoracostomy (14 gauge), tube thoracostomy (32Fr), or Reactor\u2122 thoracostomy (36Fr). Air leak was simulated throughout intervention with 40\u201380 mL\/kg\/min insufflation. Intrathoracic pressure monitoring and hemodynamic parameters were obtained at 1 and 5 minutes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Tension physiology and tension-induced pulseless electrical activity were created in all iterations. Needle thoracostomy (n = 28) was faster at 7.04 \u00b1 3.04 seconds than both Reactor thoracostomy (n = 32), 11.63 \u00b1 5.30 (p &lt; 0.05) and tube thoracostomy (n = 32), 27.06 \u00b1 10.73 (p &lt; 0.01); however, Reactor\u2122 thoracostomy was faster than tube thoracostomy (p &lt; 0.001). Physiological decompression was achieved in all patients treated with Reactor\u2122 and tube thoracostomy, but only 14% of needle thoracostomy. Cardiac recovery to complete physiologic baseline occurred in only 21% (6\/28) of those treated with needle thoracostomy whereas Reactor\u2122 or tube thoracostomy demonstrated 88% (28\/32) and 94% (30\/32) response rates. When combined, needle thoracostomy successfully treated tension pneumothorax in only 4% (1\/28) of subjects as compared to 88% (28\/32) with Reactor\u2122 thoracostomy and 94% (30\/32) with tube thoracostomy (p &lt; 0.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Needle thoracostomy provides a rapid intervention for tension pneumothorax, but is associated with unacceptably high failure rates. Reactor\u2122 thoracostomy was effective, expedient, and may provide a useful and technically simpler first-line treatment for tension pneumothorax or tension-induced pulseless electrical activity.<\/jats:p><\/jats:sec>","DOI":"10.1093\/milmed\/usz135","type":"journal-article","created":{"date-parts":[[2019,6,28]],"date-time":"2019-06-28T14:27:59Z","timestamp":1561732079000},"source":"Crossref","is-referenced-by-count":3,"title":["An Evaluation of a Novel Medical Device Versus Standard Interventions in the Treatment of Tension Pneumothorax in a Swine Model (Sus scrofa)"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4155-5224","authenticated-orcid":false,"given":"Rowan R","family":"Sheldon","sequence":"first","affiliation":[{"name":"Department of Surgery, ATTN: MCHJ-SSS-G, Madigan Army Medical Center; 9040 Jackson Avenue, Tacoma, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woo S","family":"Do","sequence":"additional","affiliation":[{"name":"Department of Surgery, ATTN: MCHJ-SSS-G, Madigan Army Medical Center; 9040 Jackson Avenue, Tacoma, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic M","family":"Forte","sequence":"additional","affiliation":[{"name":"Department of Surgery, ATTN: MCHJ-SSS-G, Madigan Army Medical Center; 9040 Jackson Avenue, Tacoma, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica B","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Surgery, ATTN: MCHJ-SSS-G, Madigan Army Medical Center; 9040 Jackson Avenue, Tacoma, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J","family":"Derickson","sequence":"additional","affiliation":[{"name":"Department of Surgery, ATTN: MCHJ-SSS-G, Madigan Army Medical Center; 9040 Jackson Avenue, Tacoma, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J","family":"Eckert","sequence":"additional","affiliation":[{"name":"Department of Surgery, ATTN: MCHJ-SSS-G, Madigan Army Medical Center; 9040 Jackson Avenue, Tacoma, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J","family":"Martin","sequence":"additional","affiliation":[{"name":"Trauma and Emergency General Surgery Service, Scripps Mercy Medical Center, 4077 5th Avenue, San Diego, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,6,28]]},"reference":[{"issue":"6","key":"2019062810131092100_usz135C1","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1097\/01.sla.0000259433.03754.98","article-title":"Causes of death in U.S. Special Operations Forces in the global war on terrorism: 2001\u20132004","volume":"245","author":"Holcomb","year":"2007","journal-title":"Ann Surg"},{"issue":"6 Suppl 5","key":"2019062810131092100_usz135C2","doi-asserted-by":"crossref","first-page":"S431","DOI":"10.1097\/TA.0b013e3182755dcc","article-title":"Death on the battlefield (2001\u20132011): implications for the future of combat casualty care","volume":"73","author":"Eastridge","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"issue":"Suppl","key":"2019062810131092100_usz135C3","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1093\/milmed\/161.suppl_1.3","article-title":"Tactical combat casualty care in special operations","volume":"161","author":"Butler","year":"1996","journal-title":"Mil Med"},{"issue":"5","key":"2019062810131092100_usz135C4","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1016\/j.amjsurg.2017.12.014","article-title":"Evaluation of a novel thoracic entry device versus needle decompression in a tension pneumothorax swine model","volume":"215","author":"Kuckelman","year":"2018","journal-title":"Am J Surg"},{"issue":"3","key":"2019062810131092100_usz135C5","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1097\/01.ta.0000209179.79946.92","article-title":"Prevalence of tension pneumothorax in fatally wounded combat casualties","volume":"60","author":"McPherson","year":"2006","journal-title":"J Trauma"},{"issue":"2","key":"2019062810131092100_usz135C6","doi-asserted-by":"crossref","first-page":"19","DOI":"10.55460\/XB1Z-3BJU","article-title":"Management of suspected tension pneumothorax in tactical combat casualty care: TCCC Guidelines Change 17-02","volume":"18","author":"Butler","journal-title":"J Spec Oper Med"},{"issue":"4","key":"2019062810131092100_usz135C7","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1136\/emj.20.4.383","article-title":"Life threatening haemorrhage after anterior needle aspiration of pneumothoraces. A role for lateral needle aspiration in emergency decompression of spontaneous pneumothorax","volume":"20","author":"Rawlins","year":"2003","journal-title":"Emerg Med J"},{"issue":"5","key":"2019062810131092100_usz135C8","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1111\/j.1742-6723.2011.01466.x","article-title":"Subclavian artery laceration: a serious complication of needle decompression","volume":"23","author":"Riwoe","year":"2011","journal-title":"Emerg Med Australas"},{"issue":"3","key":"2019062810131092100_usz135C9","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1097\/01.TA.0000046380.92001.81","article-title":"Pulmonary artery injury and cardiac tamponade after needle decompression of a suspected tension pneumothorax","volume":"54","author":"Butler","year":"2003","journal-title":"J Trauma"},{"issue":"1","key":"2019062810131092100_usz135C10","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1097\/TA.0000000000000249","article-title":"Standard laparoscopic trocars for the treatment of tension pneumothorax: a superior alternative to needle decompression","volume":"77","author":"Hatch","year":"2014","journal-title":"J Trauma Acute Care Surg"},{"issue":"5","key":"2019062810131092100_usz135C11","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1161\/CIRCULATIONAHA.106.613596","article-title":"Cardiogenic shock: current concepts and improving outcomes","volume":"117","author":"Reynolds","year":"2008","journal-title":"Circulation"},{"issue":"12","key":"2019062810131092100_usz135C12","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.1007\/s00134-014-3525-z","article-title":"Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine","volume":"40","author":"Cecconi","year":"2014","journal-title":"Intensive Care Med"},{"issue":"6","key":"2019062810131092100_usz135C13","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1097\/TA.0000000000001684","article-title":"Bigger is better: Comparison of alternative devices for tension hemopneumothorax and pulseless electrical activity in a Yorkshire swine model","volume":"83","author":"Leatherman","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"issue":"3 Suppl 3","key":"2019062810131092100_usz135C14","doi-asserted-by":"crossref","first-page":"S118","DOI":"10.1503\/cjs.012914","article-title":"Needle thoracostomy for tension pneumothorax: the Israeli Defense Forces experience","volume":"58","author":"Chen","year":"2015","journal-title":"Can J Surg"},{"issue":"6","key":"2019062810131092100_usz135C15","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1097\/TA.0b013e31825ac511","article-title":"Does needle thoracostomy provide adequate and effective decompression of tension pneumothorax?","volume":"73","author":"Martin","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"issue":"6","key":"2019062810131092100_usz135C16","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1097\/TA.0b013e318299563d","article-title":"Modified Veress needle decompression of tension pneumothorax: a randomized crossover animal study","volume":"75","author":"Lubin","year":"2013","journal-title":"J Trauma Acute Care Surg"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usz135\/28881708\/usz135.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"}],"deposited":{"date-parts":[[2022,9,22]],"date-time":"2022-09-22T09:32:42Z","timestamp":1663839162000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article\/doi\/10.1093\/milmed\/usz135\/5524886"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,28]]},"references-count":16,"URL":"https:\/\/doi.org\/10.1093\/milmed\/usz135","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,28]]},"article-number":"usz135"}}