Iatrogenic cardiac injury following prehospital needle decompression: a case report

Tension pneumothorax is a life-threatening condition that necessitates prompt intervention, typically via prehospital needle thoracostomy. However, this procedure carries risks such as cardiac injury. We report the case of a 20-year-old man involved in an all-terrain vehicle accident who presented with a low Glasgow Coma Scale (GCS) score, respiratory distress, and hypotension. Prehospital intubation and left-sided needle thoracostomy were performed for suspected pneumothorax and depressed GCS score. Pulsatile bleeding from the catheter was noted. Imaging in the trauma bay revealed catheter penetration into the left ventricle. Pan computed tomography confirmed the cardiac injury and identified a severe traumatic brain injury. The patient underwent surgical repair of the heart via median sternotomy. He recovered well and was subsequently transferred for rehabilitation. This case highlights the risks associated with emergent, blind needle thoracostomy in the prehospital setting. Improved outcomes depend on refined technique, accurate anatomical identification, and appropriate needle selection.