Iatrogenic Cardiac Injury From Prehospital Needle Thoracostomy After ATV Collision

Introduction: Needle thoracostomy is a life-saving intervention for tension pneumothorax, but improper placement, especially in the prehospital setting, can cause catastrophic complications such as penetrating cardiac injury. We present a case of iatrogenic cardiac injury from a misplaced prehospital needle decompression, underscoring the critical importance of strict adherence to anatomical landmarks and established guidelines even during urgent field interventions.


Description: A man in his fifties sustained severe blunt trauma from a high-speed all-terrain vehicle (ATV) crash. He presented with altered consciousness and respiratory distress, raising suspicion for tension pneumothorax. Emergency responders performed a needle decompression at the left third intercostal space, midclavicular line, inserting an 8 cm Russell PneumoFix-8 catheter to its full length. Immediately, pulsatile bleeding from the insertion site indicated a possible cardiac injury. Trauma center imaging confirmed that the catheter had pierced the left ventricle, causing a pericardial effusion. On arrival, the patient was intubated and sedated, with active bleeding from the thoracostomy site; evaluation revealed skull base fractures and a subarachnoid hemorrhage. An urgent median sternotomy was performed: the hemopericardium was evacuated, the intramyocardial catheter fragment was removed, and a small left ventricular laceration was repaired without cardiopulmonary bypass. His postoperative recovery was prompt, with extubation on postoperative day one and discharge from the ICU by day four.


Discussion: This case illustrates a rare, life-threatening complication of prehospital needle thoracostomy: a penetrating cardiac injury resulting from improper catheter placement. It highlights that even life-saving procedures like needle decompression carry significant risks when anatomical landmarks are not strictly observed. The case also demonstrates successful cardiac repair without cardiopulmonary bypass, a strategy chosen to avoid exacerbating the patient’s intracranial hemorrhage. In acute trauma, effective management requires rapid diagnosis using multiple imaging modalities, including ultrasound and computed tomography, prompt surgical decision-making, and strict adherence to procedural guidelines to minimize iatrogenic risk.