Comparative Analysis of Needle Thoracostomy Success Rates: A Cadaveric Study on Intercostal Space Selection
Keywords:
Intercostal Space, Midclavicular Line, Midaxillary Line, Needle ThoracostomyAbstract
Background: Needle thoracostomy is a critical intervention for tension pneumothorax, yet failure rates remain significant with traditional second intercostal space placement. Cadaveric studies suggest anatomical variations in chest wall thickness may impact success, but comparative data are limited in diverse populations. Objective: To compare the success rates of needle thoracostomy placement in the traditional second intercostal space (midclavicular line) versus the fifth intercostal space (midaxillary line) in a cadaveric model. Methodology: Thirty-two adult cadavers were studied with standardized needle thoracostomy placements in both the second and fifth intercostal spaces by using a 5-cm angiocatheters. Each site was assessed bilaterally (total 64 placements per site). Following needle insertion, thoracotomies were verified pleural cavity penetration. The thickness of chest wall was measured at both insertion points, with outcomes analyzed by gender and laterality. Results: Results showed that 5th intercostal space approach demonstrated significantly higher success rates (96.9% vs. 59.4%) and thinner chest wall thickness (3.4 ± 0.8 cm vs. 4.7 ± 1.0 cm) compared to the second intercostal space with significant effect. Gender disparities were notable, with female cadavers showing lower success rates (90% vs. 30%) and greater chest wall thickness at both sites. A 4.2 cm chest wall thickness cutoff predicted 2nd ICS failure (AUC = 0.89). Conclusion: The present study concluded that the fifth intercostal space (midaxillary line) provides significantly higher success rates for needle thoracostomy compared to the traditional second intercostal approach, particularly in female patients. The findings support updating current clinical guidelines to favor the lateral approach for more reliable emergent decompression of tension pneumothorax.References
Martin M, Satterly S, Inaba K, Blair K. Does needle thoracostomy provide adequate and effective decompression of tension pneumothorax? J Trauma Acute Care Surg. 2012;73(6):1412–7.
Azizi N, Ter Avest E, Hoek AE, Admiraal-van de Pas Y, Buizert PJ, Peijs DR, et al. Optimal anatomical location for needle chest decompression for tension pneumothorax: A multicenter prospective cohort study. Injury. 2021;52(2):213–8.
Wernick B, Hon HH, Mubang RN, Cipriano A, Hughes R, Rankin DD, et al. Complications of needle thoracostomy: a comprehensive clinical review. Int J Crit Illn Inj Sci. 2015;5(3):160–9.
Zengerink I, Brink PR, Laupland KB, Raber EL, Zygun D, Kortbeek JB. Needle thoracostomy in the treatment of a tension pneumothorax in trauma patients: what size needle? J Trauma Acute Care Surg. 2008;64(1):111–4.
Rottenstreich M, Fay S, Gendler S, Klein Y, Arkovitz M, Rottenstreich A. Needle thoracotomy in trauma. Mil Med. 2015;180(12):1211–3.
Laan DV, Vu TD, Thiels CA, Pandian TK, Schiller HJ, Murad MH, et al. Chest wall thickness and decompression failure: a systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. Injury. 2016;47(4):797–804.
7. Chang JM. Variation in thoracic wall thickness on multi-detector CT in adult patients and its implications in needle thoracostomy for tension pneumothorax. 2022. Available from URL: http://hdl.handle.net/11427/37105.
Neeki MM, Cheung C, Dong F, Pham N, Shafer D, Neeki A, et al. Emergent needle thoracostomy in prehospital trauma patients: a review of procedural execution through computed tomography scans. Trauma Surg Acute Care Open. 2021;6(1):e000752.
Inaba K, Branco BC, Eckstein M, Shatz DV, Martin MJ, Green DJ, et al. Optimal positioning for emergent needle thoracostomy: a cadaver-based study. J Trauma Acute Care Surg. 2011;71(5):1099–103.
Eifinger F, Lenze M, Brisken K, Welzing L, Roth B, Koebke J. The anterior to midaxillary line between the 4th or 5th intercostal space (Buelau position) is safe for the use of thoracostomy tubes in preterm and term infants. Paediatr Anaesth. 2009;19(6):612–7.
Wraight WM, Tweedie DJ, Parkin IG. Neurovascular anatomy and variation in the fourth, fifth, and sixth intercostal spaces in the midâ€axillary line: a cadaveric study in respect of chest drain insertion. Clin Anat. 2005;18(5):346–9.
Khoo A, Rosichâ€Medina A, Woodham A, Jessop ZM, Di Candia M, Malata CM. The relationship between the intercostal distance, patient height and outcome in microsurgical breast reconstruction using the second interspace ribâ€sparing internal mammary vessel exposure. Microsurgery. 2014;34(6):448–53.
Laan DV, Vu TD, Thiels CA, Pandian TK, Schiller HJ, Murad MH, et al. Chest wall thickness and decompression failure: a systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. Injury. 2016;47(4):797–804.
Wax DB, Leibowitz AB. Radiologic assessment of potential sites for needle decompression of a tension pneumothorax. Anesth Analg. 2007;105(5):1385–8.
Zengerink I, Brink PR, Laupland KB, et al. Needle thoracostomy in the treatment of a tension pneumothorax in trauma patients: what size needle? J Trauma. 2008;64(1):111–4.
Givens ML, Ayotte K, Manifold C. Needle thoracostomy: implications of computed tomography chest wall thickness. Acad Emerg Med. 2004;11(2):211–3.
Ball CG, Wyrzykowski AD, Kirkpatrick AW, et al. Thoracic needle decompression for tension pneumothorax: clinical correlation with catheter length. Can J Surg. 2010;53(3):184–8.
Rawlins R, Brown KM, Carr CS, Cameron CR. Life threatening haemorrhage after anterior needle aspiration of pneumothoraces. Emerg Med J. 2003;20(4):383–4.
Sanchez LD, Straszewski S, Saghir A, Khan A, Horn E, Fischer C, et al. Anterior versus lateral needle decompression of tension pneumothorax: comparison by computed tomography chest wall measurement. Acad Emerg Med. 2011;18(9):1022–6.
Ferrie EP, Collum N, McGovern S. The right place in the right space? Awareness of site for needle thoracocentesis. Emerg Med J. 2005;22(11):788–9.
Stevens RL, Rochester AA, Busko J, Blackwell T, Schwartz D, Argenta A, et al. Needle thoracostomy for tension pneumothorax: failure predicted by chest computed tomography. Prehosp Emerg Care. 2009;13(1):14–7.
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