Page 25 - JSOM Winter 2025

TABLE 2 NDC Attempts and Outcomes
Group, no. (%)
Outcome 10ga; n=58 14ga; n=58 P value
Successful NDC 53 (91.4) 53 (91.4) 1.00
NDC Location
5th ICS AAL
Successful 27 (50.9) 26 (49.1)
Unsuccessful 3 (60.0) 2 (40.0)
2nd ICS MCL
Successful 26 (49.1) 27 (50.9)
Unsuccessful 2 (40.0) 3 (60.0)
Median (IQR) speed, s
All 22.0 (14.5–42.0) 39.8 (30.3–57.6) <.001
Excluding failures 21.7 (14.4–37.8) 37.7 (29.2–57.4) <.001
NDC audibility
Silent
Successful 3 (75.0) 1 (25.0)
Unsuccessful 1 (100.0) 0 (0.0)
Audible with needle in catheter .03
Successful 32 (65.3) 17 (34.7)
Unsuccessful 0 (0.0) 1 (100.0)
Audible after needle removed
Successful 20 (35.7) 36 (64.3)
Unsuccessful 2 (20.0) 3 (60.0)
NDC = needle decompression; IQR = interquartile range; ga = gauge; ICS = intercostal space; AAL = anterior axillary line; MCL = midclavicular line.

The 10ga needle/catheter units demonstrated significantly faster vs. 34.7%; P=.034). Fifty-two out of 53 successful decom-
decompression times compared to 14ga needle/catheter units pressions with the 10ga needle/catheter units had an audible
(22.0s [IQR 14.5–42.0] vs. 39.8s [IQR 30.3–57.6], P<.001). release of air, with 32 (65.3%) of these instances occurring
Figure 3 illustrates the time to decompression by needle/ while the needle was still in place. Among the five unsuccessful
catheter unit. decompressions with the 10ga needle/catheter units, two also
had an audible release of air, both with the needle still in place.
FIGURE 3 Needle decompression time to tension pneumothorax In contrast, all 53 successful decompressions with the 14ga
decompression to <4mmHg in seconds by needle/catheter unit
gauge size. needle/catheter units were accompanied by an audible release
of air, though only 17 (34.7%) of these occurred with the nee-
dle still in place. Additionally, 34 (64.7%) of audible decom-
pressions in the successful 14ga decompressions occurred once
the needle was removed.

Discussion

While this study did not reveal a significant difference in the
rate of successful NDC among 10g and 14ga fenestrated needle/
catheter units, it did demonstrate that 10ga needle/catheter
units decompress a human model of tPTX an average of 17s
faster than 14ga units, which could be clinically significant for
patients in extremis. Furthermore, the optimal site for NDC of
tPTX has long been a subject of differing clinical opinions, with
both the AAL and the 2nd intercostal space midclavicular line
(2nd ICS MCL) commonly used in practice. Our hypothesis
anticipated a higher success rate at the 2nd ICS MCL site based
No difference was found in time to successful decompression upon clinical evidence published; however, this study found no
between AAL and MCL sites (36.0s [IQR 21.7–51.7] v.s 30.4s significant difference in success rates between the two loca-
[IQR 18.7–49.5], P=.46). Stratification by needle/catheter unit tions. 15–20 Specifically, we observed no significant variation in
size between sites also showed no significant difference in decompression success when using 10ga and 14ga needle/cath-
success proportion (10ga, P=1.0; 14ga, P=1.0) or in duration eter units in the 5th ICS AAL compared to the 2nd ICS MCL
(10ga, P=.46; 14ga, P=.76). locations in cadaveric models using a simulated tPTX model.

In this study, the 10ga needle/catheter units achieved an audi- While Table 3 details the endpoint pressures and durations
ble release of air with the needle still in place during success- for each of the 10 NDCs, the precise reasons for failure to
ful NDC more frequently compared to the 14ga units (65.3% decompress intrathoracic pressure to below 4mmHg remain

10-Gauge versus 14-Gauge NDC for tPTX | 23