Page 22 - JSOM Winter 2025

10-Gauge versus 14-Gauge Fenestrated Needle/Catheter Units
for Decompression of Tension Pneumothorax in Cadaveric Model

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Adrianna N. Long, MD *; Jennifer Achay, BS, NRP ; Ian L. Hudson, DO, MPH ;
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Joshua B. Lowe, MD ; Emily Epley, BS, NRP ; Scotty Bolleter, BS, EMT-P ; Erik DeSoucy, DO, FACS ;
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Christopher Hewitt, DO, MPH ; Jeffrey E. Rollman, MPH ; Jeffrey Swenson, BS ;
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David Wampler, PhD ; Emily Raetz, MD ; Adam Kruse, MD, MPH, MS 13
ABSTRACT
Background: Needle decompression (NDC) is the primary as well as nontraumatic causes (including chronic pulmonary
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treatment of tension pneumothorax (tPTX) in prehospital disease and connective tissue disorders). Needle thoracos-
settings. This study compared 10-gauge (10ga) and 14-gauge tomy or needle decompression (NDC) is the standard of care
(14ga) fenestrated needle/catheter units for NDC. We hypoth- treatment for tPTX in the civilian prehospital setting and in
esized 10ga needle/catheter units would demonstrate higher the Tactical Combat Casualty Care (TCCC) guidelines. Al-
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tPTX decompression rates compared to 14ga needle/catheter though the optimal needle length has been extensively studied,
units. Methods: A non-randomized, non-blinded study was research on needle gauge in relation to tPTX resolution has
conducted using human cadavers with artificially induced tPTX thus far been limited to studies conducted on swine. 6–11 The
(pleural pressure of 15mmHg). A 10ga or 14ga unit was in- 10-gauge (10ga) catheters have previously shown to be supe-
serted into the 5th intercostal space, anterior axillary line, or the rior to 14-gauge (14ga) catheters for return of spontaneous cir-
2nd intercostal space, midclavicular line. Successful NDC was culation (ROSC) following tension pulseless electrical activity
defined as a pressure decrease to less than 4mmHg. Results: In (tPEA) in a 30% induced hemorrhage model in a swine study,
116 NDC attempts, there was no difference in the success rate yet the TCCC guidelines recommend a 10ga or a 14ga cathe-
of NDC between 10ga versus 14ga units (91.1% vs. 91.1%, ter for NDC. 2,10 Studies have identified a minimum needle and
P=1.0). The median time to decompression of tPTX was faster catheter length of at least 2.75 inches to successfully decom-
using 10ga at 22.0s (IQR 14.5–42.0) vs. 14ga at 39.8 seconds press pneumothorax in 95% of patients with tPTX physiology;
(IQR 30.3–57.6, P<.001). No difference was found in time to TCCC guidelines recommend a 3.25-inch (8.25cm) length nee-
successful decompression between AAL and MCL sites (36.0s dle/catheter unit. 6,7
[IQR 21.7–51.7] vs. 30.4s [IQR 18.7–49.5], P=.46). The 10ga
needle/catheter units achieved an audible release of air with the Although NDC has often been described as producing an au-
needle still in place during successful NDC more frequently dible release of air, this is difficult to hear in noisy prehospital
compared to the 14ga units (65.3% vs. 34.7%; P=.034). Con- and combat environments. 5,9,12 Current TCCC recommenda-
clusion: NDC with 10ga fenestrated needle/catheter units was tions call for leaving the needle in place for up to 10 second(s)
similarly effective, but significantly faster than 14ga units for when a patient is in extremis; however, this may impede air-
tPTX in a cadaveric model. A safe, depth-limiting technique flow in smaller-gauge catheters. There is no literature compar-
was over 90% effective across all NDC sites. ing various gauge needle/catheter units’ evacuation rates or
audibility of decompression when treating tPTX.
Keywords: tension pneumothorax; needle thoracostomy;
decompression; cadaver; needle gauge; gauge size Additionally, debate continues regarding the ideal location
for pneumothorax decompression, with some advocating for
an anterior approach due to the decreased distance from the
skin to the pleura between the 2nd intercostal space (ICS)
Introduction
midclavicular line (MCL) compared to the anterior axillary
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Tension pneumothorax (tPTX) is a life threatening condition in line (AAL) at the 5th ICS. Other studies argue that the AAL
both civilian and military prehospital settings that should be ad- approach provides a higher likelihood for successful pneumo-
dressed immediately upon recognition. Tension pneumothorax thorax decompression; however, a needle length of 8cm (3.15
may arise from traumatic mechanisms (including penetrating inches) has been associated with higher risk of iatrogenic car-
trauma such as a gunshot wound, blunt trauma, barotrauma) diac injury on the left lateral approach in as many as 48% of
*Correspondence to Adrianna N. Long, Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX, 78234 or adrianna.long.
md@gmail.com
1 LTC Adrianna N. Long is affiliated with the University of Texas Health Science Center San Antonio, TX (UTHealth), and the Brooke Army
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Medical Center, San Antonio, TX (BAMC). Jennifer Achay is affiliated with the Center for Emergency Health Sciences, Spring Branch, TX
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(CEHS). LTC Ian L. Hudson is affiliated with UTHealth and BAMC. Maj Joshua B. Lowe is affiliated with UTHealth and BAMC. Emily Epley
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is affiliated with CEHS. Scotty Bolleter is affiliated with CEHS. LtCol Erik DeSoucy is affiliated with the ODP/Trauma Burn and Rehabilita-
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tive Medicine Team, U.S. Embassy, Abu Dhabi. LtCol Christopher Hewitt is affiliated with UTHealth and BAMC. Jeffrey E. Rollman is affil-
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iated with UTHealth. TSgt Jeffrey Swenson is affiliated with the 351st Special Warfare Training Squadron, Kirtland AFB, Albuquerque, NM.
11 Dr. David Wampler is affiliated with UTHealth. LCDR Emily Raetz is affiliated with UTHealth and BAMC. Maj Adam Kruse is affiliated
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with the Wright-Patterson Medical Center, Wright-Patterson Air Force Base, Dayton, OH.
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