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30 MARCH 2015 | EMSWORLD.com NEEDLE DECOMPRESSION ful in 50% of trauma patients based on its patient population. 15 Kenji Inaba, MD, and colleagues took this idea one step further. They conducted a retrospective review that compared CWT using CT imaging at the 2ICS-MCL to the fifth intercostal space-anterior axillary line (5ICS-AAL). Thirty randomly selected patients from four predefined BMI quartiles were included for a total of 120 patients. The results were notable for a stepwise increase in CWT in each BMI quartile at both sites. Furthermore, the CWT was statistically greater at the 2ICS-MCL compared to the 5ICS-AAL. Using a 5-cm needle, 42.7% of needle decompressions would be expected to fail at the 2ICS-MCL, compared to 16.7% at the 5ICS-AAL. 10 These results were con- tradicted by a review done by Leon San- chez, MD, et al. in 2011. 14 Scans from 159 patients yielded a statistically greater CWT at the fourth ICS and 5ICS-AAL compared to 2ICS-MCL. Addition- ally, the failure rate based on a 5-cm needle at the 2ICS-MCL was lower (33.6%) compared to the 4ICS-MAL (73.6%) and 5ICS-MAL (55.3%), all statistically significant differences. 14 The next logical step was to assess the differences in radiographic decompression using a longer needle. Samuel Chang, MD, et al. performed a retrospective review of 100 CT scans from trauma patients com- paring CWT and radiographic decompres- sion success rates using 5-cm versus 8-cm angiocatheters. The results revealed CWT was significantly thicker at the 2ICS-MCL compared to 4ICS-AAL. Using an 8-cm nee- dle, radiographic decompression achieved success at least 96% of the time independent of the site selected. Using a 5-cm needle, radiographic decompression was achieved 66%–76% of the time at the 2ICS-MCL and 75%–81% of the time at the 4ICS-AAL. Authors also noted that radiologic noninjury (defined as the distance to a vital structure greater than needle length) rates were higher for the 5-cm needle (99% or higher at all sites) com- pared to the 8-cm (68%–100% depending on site). Furthermore, the lateral approach on the left significantly increased the risk of damaging vital structures, mainly the left ventricle, when using an 8-cm needle. 5 Simulated Decompression The majority of the aforementioned stud- ies comparing chest wall thickness were based on radiographic measurements alone. They did not consider variables for which a EMS1503 For More Information Circle 27 on Reader Service Card THE NEXT LOGICAL STEP WAS TO ASSESS THE DIFFERENCES IN RADIOGRAPHIC DECOMPRESSION USING A LONGER NEEDLE.