Malfunction of a Heimlich flutter valve causing tension pneumothorax: case report of a rare complication

Background Thoracic injuries play an important role in major trauma
patients due to their high incidence and critical relevance. A
serious consequence of thoracic trauma is pneumothorax, a condition
that quickly can become life-threatening and requires immediate
treatment. Decompression is the state of the art for treating
tension pneumothorax. There are many different methods of
decompression using different techniques, devices, valves and
drainage systems. Referring to our case report we would like to
discuss the utilization of these devices. Case presentation We
report of a patient suffering from tension pneumothorax despite
insertion of a chest drain at the accident scene. The decompression
was by tube thoracostomy which was connected to a Heimlich flutter
valve. During air transportation the patient suffered from
cardiorespiratory arrest with asystole and was admitted to the
trauma room undergoing manual chest compressions. The initial chest
film showed a persisting tension pneumothorax, despite the chest
tube that had been correctly placed and connected properly to the
Heimlich valve. We assume that the Heimlich valve leaves did not
open up and thus tension pneumothorax was not released. Conclusion
We would like to raise awareness to the fact that if a Heimlich
flutter valve is applied in the pre-hospital setting it should be
used with caution. Failure in this type of valve may lead to
recurrent tension pneumothorax.