UMEM Educational Pearls

Needle Decompression - Are we Teaching the Right Location?

  • Tension pneumothorax frequently results in circulatory collapse and may lead to cardiopulmonary arrest.
  • In the event that tube thoracostomy cannot be immediately performed, traditional teaching is to perform needle decompression in the second intercostal space, mid-clavicular line using a 5-cm angiocath needle.
  • Recent literature, however, has challenged the traditional location for needle decompression.  In fact, researchers found:
    • Needles placed in the second intercostal space often failed to enter the chest cavity and relieve tension physiology.
    • Needles placed in the fifth intercostal space in the anterior axillary line were more likely to enter the chest cavity with a lower failure rate.
  • Take Home Point: It may be time to reconsider the optimal position for needle decompression of tension pneumothorax.


Inaba K, et al. Optimal positioning for emergent needle thoracostomy: A cadaver-based study. J Trauma 2011; 71:1099-1103.

Inaba K, et al. Radiologic evaluation of alternative sites for needle decompression of tension pneumothorax. Arch Surg 2012; 147:813-8.

Martin M, et al. Does needle decompression provide adequate and effective decompression of tension pneumothorax? J Trauma 2012; 73:1412-1417.