R.E.B.E.L.EM - 21 March, 2016 - Post Peer Reviewed By: Anand Swaminathan
Ref: Laan DV et al. Chest Wall Thickness and Decompression Failure: A systematic Review and Meta-Analysis Coparing Anatomic Locations in Needle Thoracostomy. Injury 2015 [Epub Ahead of Print]. PMID: 26724173
"Background: Currently the Advanced Trauma Life Support (ATLS) guidelines recommend initial treatment of decompression of a tension pneumothorax, as needle thoracostomy (NT) using a 5cm angiocatheter at the 2nd intercostal space (ICS2) in the mid clavicular line (MCL). With the growth of size in our population worldwide, there has been increasing evidence about two things:
- A 5cm angiocatheter may not be long enough to reach the pleural space
- The 2nd intercostal space at the mid clavicular line (ICS2-MCL) may not be the ideal location for needle decompression
What other Alternative Locations are Possible for Needle Decompression:
- 4th/5th Intercostal Space at the Mid Axillary Line (4th/5th ICS-MAL)
- 4th/5th Intercostal Space at the Anterior Axillary Line (4th/5th ICS-AAL)
Clinical Take Home Points:
- Best evidence suggests that the 4th/5th ICS-AAL has the lowest predicted failure rate of needle decompression with a 5cm angiocatheter
- Given the increasing BMI of the population, a 5cm angiocatheter may not be long enough to reach the pleural space, but must be balanced with a risk of causing injury to vital structures with longer needles"
