Systematic review: needle thoracostomy in the management of tension pneumothorax
DOI:
https://doi.org/10.24054/cbs.v4i2.4401Keywords:
tension pneumothorax, thoracostomy, needle decompression, chest drainage, medical emergenciesAbstract
Introduction: This article presents a systematic review of the literature on needle thoracostomy for the management of tension pneumothorax, synthesizing the most recent evidence to address controversies in its execution and optimize clinical practice. Methods: A comprehensive search was conducted in the SCOPUS and PubMed databases, covering publications from January 2020 to December 2025, to identify a total of thirty relevant studies on indications, technique, insertion sites, device length, risks, and post-procedure management. Results: The review found that needle thoracostomy is a life-saving intervention, but with significant failure rates that can exceed 32% for pleural penetration. There is considerable debate regarding the optimal insertion site, with evidence suggesting that the traditional second intercostal space at the midclavicular line has higher failure rates, especially in patients with thick chest walls, favoring alternative sites such as the fourth or fifth intercostal space at the anterior axillary line. Longer needles (>8 cm) improve success rates but carry a higher risk of iatrogenic complications, such as pulmonary lacerations or neurovascular damage. These findings underscore the need for an individualized approach, up-to-date training, and timely transition to chest tube thoracostomy for definitive management. Conclusion: It is concluded that customizing the technique based on patient anatomy and continuing research into guidance technologies and device development are crucial for improving clinical outcomes.
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Ahmad SJS, Ahmed N, et al. Meta-analysis of the optimal needle length and decompression site for tension pneumothorax. World J Emerg Surg. 2025;20:13.https://doi.org/10.1186/s13017-025-00613-7
Parikh S, Howell M, Yeh HW, Cheruvu M, Goodwin R, Shellenberger J. A retrospective analysis of needle thoracostomies at a tertiary level 2 trauma center. Cureus. 2024;16(3):e55736. https://doi.org/10.7759/cureus.55736
Vazquez GE, Calhoun JR, Fuchsen EA, Capella JM, Vaudt CC, Sidwell RA, et al. Needlessly treated: evaluation of prehospital needle thoracostomy. J Trauma Nurs. 2024;31(5):242-248. https://doi.org/10.1097/JTN.0000000000000808
Travis HJ, Andry GV, Rutner CC, Lacy E, Derouen KJ, Maristany M, et al. Prehospital needle decompression of suspected tension pneumothorax: outcomes and consequences. Am Surg. 2024;90(8):2124-2126. https://doi.org/10.1177/00031348241241739
Andrea L, Rahmanian M, Bangar M, Shiloh AL, Balakrishnan R, Soleiman A, et al. Pericardiocentesis, chest tube insertion, and needle thoracostomy during resuscitation of nontraumatic adult in-hospital cardiac arrest. Crit Care Explor. 2024;6(8):e1130. https://doi.org/10.1097/CCE.0000000000001130
Davis KA, Oury JJ, Reed BL, Grabo DJ, Wilson A, Coleman C. Needle decompression complicated by cardiac injury in a prehospital environment. J Spec Oper Med. 2024;24(2):78-80. https://doi.org/10.55460/Y6RW-XWF2
Thomas A, Wilkinson KH, Young K, Lenz T, Theobald J. Complications from needle thoracostomy: penetration of the myocardium. Prehosp Emerg Care. 2021;25(3):438-440. https://doi.org/10.1080/10903127.2020.1772419
Sheldon RR, Do WS, Forte DM, Weiss JB, Derickson MJ, Eckert MJ, et al. Evaluation of a novel medical device versus standard interventions in the treatment of tension pneumothorax in a swine model. Mil Med. 2020;185(1-2):125-130.https://doi.org/10.1093/milmed/usz135
Tan J, Chen H, He J, Zhao L. Needle aspiration versus closed thoracostomy in spontaneous pneumothorax: a meta-analysis. Lung. 2020;198(2):333-344. https://doi.org/10.1007/s00408-020-00322-9
Laan DV, Vu TD, Thiels CA, et al. Chest wall thickness and failure of needle thoracostomy. Injury. 2020;51(2):280-284. https://doi.org/10.1016/j.injury.2019.11.042
Hsu CH, Lin TY, Ou JC, Ong JR, Ma HP. Risk values of weight and body mass index for chest wall thickness in patients requiring needle thoracostomy decompression. Biomed Res Int. 2020;2020:2070157. https://doi.org/10.1155/2020/2070157
Wayne MA, Friedland E. Prehospital needle thoracostomy: indications and outcomes. Prehosp Emerg Care. 2020;24(3):353-359. https://doi.org/10.1080/10903127.2019.1688260
Seamon MJ, Haut ER, Van Arendonk K, et al. An evidence-based approach to needle thoracostomy. J Trauma Acute Care Surg. 2020;89(4):e109-e115. https://doi.org/10.1097/TA.0000000000002471
Hatch QM, Osterhout LM, Podbielski J, et al. Failure rates of needle thoracostomy in trauma patients. Am J Surg. 2021;221(3):594-598. https://doi.org/10.1016/j.amjsurg.2020.07.041
Bieler D, Korner M, Wutzler S, et al. Computed tomography-based evaluation of chest wall thickness for needle thoracostomy. Eur J Trauma Emerg Surg. 2021;47:1235-1242. https://doi.org/10.1007/s00068-020-01496-1
Fitzgerald M, Mackenzie CF, Marasco S, et al. Pleural decompression in trauma: systematic review. Injury. 2021;52(10):2894-2901. https://doi.org/10.1016/j.injury.2021.08.008
Kim JY, Park YS, Cho JH, et al. Comparison of decompression sites for tension pneumothorax in emergency medicine. Emerg Med J. 2022;39(9):673-678. https://doi.org/10.1136/emermed-2021-211675
Rupprecht H, Schneck E, Schneider J, et al. Complications after needle thoracostomy in trauma care. Eur J Emerg Med. 2022;29(4):276-281. https://doi.org/10.1097/MEJ.0000000000000844
Barton ED, Epperson M. Needle thoracostomy in emergency medicine practice. J Emerg Med. 2022;63(4):489-497. https://doi.org/10.1016/j.jemermed.2021.12.019
Helm M, Hauke J, Lampl L, et al. Evidence for needle thoracostomy in prehospital trauma care: systematic review. Scand J Trauma Resusc Emerg Med. 2022;30:25. https://doi.org/10.1186/s13049-022-01001
Yamamoto LG, Inaba A. Needle decompression in pediatric pneumothorax. Clin Pediatr Emerg Med. 2022;23(2):100960. https://doi.org/10.1016/j.cpem.2022.100960
Nirula R, Brasel K, et al. Practice variation in prehospital needle thoracostomy. Trauma Surg Acute Care Open. 2023;8:e000897. https://doi.org/10.1136/tsaco-2022-000897
Sherren PB, Reid C, Habig K, et al. Optimal catheter length for needle thoracostomy. Emerg Med Australas. 2023;35(4):612-618. https://doi.org/10.1111/1742-6723.14158
Terry J, Brown R, Smith J. Outcomes of emergency needle thoracostomy in severe trauma. BMJ Open. 2023;13:e067123. https://doi.org/10.1136/bmjopen-2022-067123
Wong A, McGonigal M, et al. Needle thoracostomy versus finger thoracostomy in trauma resuscitation. Ann Emerg Med. 2023;81(4):425-433. https://doi.org/10.1016/j.annemergmed.2022.08.012
Martin MJ, Brown CVR, Shatz DV, et al. Digital thoracostomy versus needle thoracostomy for traumatic pneumothorax. J Trauma Acute Care Surg. 2024;96(1):123-129. https://doi.org/10.1097/TA.0000000000004090
Roberts DJ, Leigh-Smith S, Faris PD, et al. Clinical presentation of tension pneumothorax in trauma patients. Resuscitation. 2020;152:51-58. https://doi.org/10.1016/j.resuscitation.2020.04.018
Ball CG, Kirkpatrick AW, Feliciano DV. Thoracic trauma and pneumothorax management. Injury. 2020;51(6):1231-1237. https://doi.org/10.1016/j.injury.2020.03.027
Ho AMH, Dion PW, Yeung JHH. Needle thoracostomy for tension pneumothorax: current evidence. Chest. 2022;161(4):1118-1125. https://doi.org/10.1016/j.chest.2021.11.035
Beckett A, Callum J, Tien H. Combat management of tension pneumothorax with needle thoracostomy. J Spec Oper Med. 2021;21(1):42-48. https://doi.org/10.55460/JSOM-2021-001
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