April 19, 2021

Background: Tension Pneumothorax (TP) can occur as a potentially life-threatening complication of chest trauma. With the risk of respiratory and cardiac arrest, an immediate temporizing intervention for this condition is required by direct Needle Decompression (ND). In 2018, the Advanced Trauma Life Support (ATLS) recommendations changed from the 2nd intercostal space in the midclavicular line (ICS2-MCL) to the 4th/5th intercostal space just anterior to the anterior-axillary line (ICS4/5-AAL), whereas the European Trauma Course (ETC) trauma guidelines and the guidelines from the Royal College of Surgeons of Edinburgh (RCSEd) in the UK still adhere to placement in the ICS2-MCL for the preferred location of ND. Both chest wall thickness of the patient and needle length both play a role in the success rate of ND.  Although it is well known that Chest Wall Thickness (CWT) increases with BMI, it is unknown if the optimal place for ND may vary with BMI.