Tension pneumothorax has been identified as a potential cause of non-hypovolemic cardiac arrest in trauma casualties, both in civilian and military research studies and retrospective reviews.

The data highlighting the improved casualty outcomes with needle decompression of the chest (NDC) is largely centered on casualties who were not in cardiac arrest, but there is some retrospective information to support its utility in pulseless casualties, as well. For example, in one retrospective study of 20,330 advanced life support paramedic calls, 12 patients in cardiac arrest were treated with NDC, and three of them had a return of cardiac output.

And there are anecdotal examples of success, including a casualty injured during a mounted IED attack in 2011 where the casualty was unconscious from closed head trauma and lost their vital signs during the prehospital phase. When a bilateral needle decompression was done in the emergency room there was a rush of air from a left-sided tension pneumothorax and a subsequent return of vital signs.

The Armed Forces Medical Examiner’s office has also identified undiagnosed tension pneumothoraxes in autopsies of casualties from our recent conflicts.

Based on this information, several authors and subject matter experts recommend that for combat trauma casualties without a pulse, bilateral NDCs should be performed due to the potential benefit and clear absence of additional harm. As a result, the TCCC Guidelines now state: “… casualties with torso trauma or polytrauma who have no pulse or respirations during TFC should have bilateral needle decompression performed to ensure they do not have a tension pneumothorax prior to discontinuation of care.”