SynthesisWorld journal of emergency surgery : WJES2025
Meta-analysis of the optimal needle length and decompression site for tension pneumothorax and consensus recommendations on current ATLS and ETC guidelines.
Synthesis in World journal of emergency surgery : WJES, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Severe trauma care: advances and future directions in diagnostic and therapeutic techniques and information technology support.Medical review (2021) · 2026Article
- Anesthetic Management of Acute Right Tension Pneumothorax in a Child With Left Main Bronchial Foreign Body: A Case Report.Clinical case reports · 2026Article
- Chinese expert consensus on the prehospital management of major trauma.Chinese journal of traumatology = Zhonghua chuang shang za zhi · 2026Article
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53 authors.
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Abstract
backgroundTension pneumothorax (TP) is a life-threatening condition. The immediate recommended management is needle decompression (ND), followed by the insertion of an intercostal chest drain. The European Trauma Course (ETC) and the Advanced Trauma Life Support (ATLS) guidelines differ on needle size and decompression site, creating clinical uncertainty. This meta-analysis aims to explore the optimal approach for emergency needle decompression in TP.
methodsThis meta-analysis followed the PRISMA 2020 guidelines. It included English-language RCTs, cohort, case-control, cross-sectional studies, and case series with more than six patients. Studies on adults undergoing needle decompression therapy for TP or with chest wall thickness measurements were included. Ovid MEDLINE, Embase, and Web of Science databases were searched until May 31, 2024. Data were extracted, assessed for quality using OCEBM and GRADE, and analyzed using SPSS and OpenMeta with random-effects models. PRIMARY OUTCOME: needle decompression failure rate. SECONDARY OUTCOMES: patient demographics, cannula size, and chest wall thickness comparisons.
resultsThis review analyzed 51 studies on needle decompression for TP, with a weighted mean patient age of 36.67 years. Radiological data from 24 studies (n = 8046) indicated a 32.84% failure rate for needle penetration into the pleural cavity (I
conclusionBased on our meta-analysis, a 7 cm needle may be appropriate for decompression of right-sided tension pneumothorax at either the 5th intercostal space along the midaxillary line or the 2nd intercostal space along the midclavicular line. For left-sided cases, given the potential risk of cardiac injury, the 2nd midclavicular line is a safer option. However, these recommendations should be interpreted with caution due to considerable heterogeneity among the included studies, potential risk of bias, and variability in measurement techniques. Clinical decisions should always be individualized, taking into account patient-specific factors.
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