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Optimal positioning for emergent needle thoracostomy: a cadaver-based study.

Kenji Inaba¹, Bernardino C Branco, Marc Eckstein

¹Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, California 90033-4525, USA. kinaba@surgery.usc.edu

The Journal of Trauma

|November 11, 2011

Summary

Needle thoracostomy placement in the fifth intercostal space achieved 100% success in cadavers, significantly outperforming the traditional second intercostal space. This alternative site may improve needle penetration for treating tension pneumothorax.

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Area of Science:

Emergency Medicine
Trauma Surgery
Anatomy

Background:

Needle thoracostomy is critical for tension pneumothorax relief.
High failure rates are linked to improper needle placement.
Current guidelines recommend the second intercostal space, midclavicular line.

Purpose of the Study:

To evaluate needle thoracostomy placement in the fifth intercostal space, midaxillary line.
To compare its success rate with the traditional second intercostal space placement.
To test the hypothesis that the fifth intercostal space yields higher successful placement rates.

Main Methods:

Twenty adult cadavers were used for evaluation.
Needles were inserted into both the fifth and second intercostal spaces on both sides.
Chest wall thickness was measured, and thoracotomy assessed needle penetration into the pleural cavity.

Main Results:

100% of needles in the fifth intercostal space successfully penetrated the chest cavity.
Only 57.5% of needles in the second intercostal space were successful.
The chest wall was, on average, 1 cm thinner at the fifth intercostal space.

Conclusions:

The fifth intercostal space, midaxillary line offers a 100% success rate for needle thoracostomy in cadavers.
This site is associated with a thinner chest wall, potentially improving needle placement success.
Further clinical studies are needed to validate these cadaveric findings in live patients.