Needle thoracostomy is a lifesaving emergency procedure performed in the prehospital setting to relieve tension pneumothorax. Despite its widespread use, reported failure rates remain high. These failures are thought to result in part from variability in patient chest wall thickness and differences in recommended catheter lengths and insertion sites across clinical and EMS protocols. This literature review examines the relationship between chest wall thickness, catheter length, and procedural success in prehospital needle thoracostomy. A review of published studies evaluating needle thoracostomy outcomes is being conducted. Studies are screened for data describing chest wall thickness measurements, catheter length used, anatomical insertion site (midclavicular, anterior axillary, or midaxillary), and reported procedural success rates. Relevant variables are extracted and compared to identify patterns in successful decompression relative to anatomical location and catheter length. Trends in the literature suggest that chest wall thickness varies significantly by insertion site and patient characteristics. Several studies indicate that standard catheter lengths may be insufficient in some patient populations, potentially contributing to failed decompression. Higher success rates have been reported when longer catheters are used or when decompression is performed at alternative anatomical sites where chest wall thickness is typically reduced. However, inconsistencies in measurement techniques and outcome definitions limit direct comparison between studies. By synthesizing available evidence, this review aims to clarify how anatomical variation influences prehospital needle thoracostomy success and to identify trends that may inform future EMS protocol development, equipment selection, and training for prehospital providers.
