From Guesswork to Certainty: Is Colorimetric Capnography the Next Standard for Needle Decompression?

When seconds count in the management of a tension pneumothorax, precision and confirmation are everything. Needle thoracostomy, or needle decompression, has been the frontline emergency procedure to relieve life-threatening intrathoracic pressure. Traditionally, success has been determined by subjective cues like a rush of air, clinical improvement, or audible changes. But as with many critical interventions, relying on subjective signs alone can be dangerously misleading especially in chaotic prehospital environment

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In recent years, a promising adjunct has emerged: colorimetric capnography for needle decompression. This technology detects carbon dioxide (CO₂) and provides immediate, visual feedback confirming that the needle has entered the pleural space. While we are familiar with colorimetric capnography for ET tube placement, using it for chest decompression is relatively new. Could this simple addition become the gold standard for needle decompression?

The Science Behind the Shift

Some studies have supported the potential of colorimetric capnography to enhance both the safety and accuracy of needle thoracostomy. A 2017 study in Chest demonstrated that using colorimetric capnography resulted in a 100% success rate in a swine model of tension pneumothorax, compared to just 60% success with traditional methods. The device provided rapid, objective confirmation within seconds of insertion. Granted, this is a very small study that I personally feel would need to be scaled up with both military and civilian providers in order to give us real data.

Similarly, a pilot human study announced in General Thoracic and Cardiovascular Surgery proposes that capnography may provide immediate and reliable confirmation of pleural entry in emergency department patients.

Devices such as the Capnospot have also shown impressive field results, providing visual color change feedback to guide providers even in chaotic prehospital settings.

Why It Matters

Misplaced needle thoracostomies are well-documented and carry substantial morbidity. An improperly placed needle can lead to worsening pneumothorax, vascular injury, or a false sense of security. Add the fact that providers currently rely on subjective methods to confirm the needle made it into the pleural space, the addition of colorimetric capnography could reduce human error by offering a simple, visual indicator of success.

The benefits include:

• Rapid confirmation in high-pressure situations

• Decreased reliance on subjective indicators like "gush of air"

• Improved provider confidence and potentially better patient outcomes

  
  

The Case for Caution

Despite encouraging data, widespread adoption has been slow. Some clinicians question whether the technology adds meaningful value in environments where ultrasound guidance (despite the lack of pre-hospital unltrasound in most EMS systems) or clinical judgment has already proven effective. Additionally, cost and device availability could be barriers, especially in rural or resource-limited systems.

Further large-scale human trials are needed to definitively prove that colorimetric capnography improves survival rates or reduces complications compared to standard practice.

Should It Be the New Standard?

There’s growing consensus that colorimetric confirmation holds promise as a supplemental tool rather than a replacement for clinical assessment. However, the combination of speed, simplicity, and objectivity makes a strong case for inclusion in standard needle decompression kits.

As tactical, prehospital, and emergency medicine continue to push for evidence-based improvements, the question remains: will colorimetric capnography soon become not just an optional enhancement, but a new standard of care?

At Penn Tactical Solutions, we believe any tool that improves safety and reduces ambiguity in life-saving procedures deserves serious consideration. The future of needle decompression may very well be brighter and color-changing.

A student decompressing a tension pnuemothorax in a Penn Tactical Solutions TCCC Course. (NOTE: In this scenario, an 18g IV needle is being used to simulate an chest decompression needle in order to prevent damage to the manikin. A chest decompression needle is typically a 10 or 14g needle that is 3.25" long)

The Capnospot changes from blue to yellow when C02 is detected

Naik ND, Hernandez MC, Anderson JR, Ross EK, Zielinski MD, Aho JM. Needle Decompression of Tension Pneumothorax with Colorimetric Capnography. Chest. 2017 Nov;152(5):1015-1020. doi: 10.1016/j.chest.2017.04.179. Epub 2017 May 10. PMID: 28499514; PMCID: PMC5812769.

Musa, J., Zielinski, M., Hernandez, M. et al. Tension pneumothorax decompression with colorimetric capnography: pilot case series. Gen Thorac Cardiovasc Surg 70, 59–63 (2022). https://doi.org/10.1007/s11748-021-01686-2

Wernick B, Hon HH, Mubang RN, Cipriano A, Hughes R, Rankin DD, Evans DC, Burfeind WR Jr, Hoey BA, Cipolla J, Galwankar SC, Papadimos TJ, Stawicki SP, Firstenberg MS. Complications of needle thoracostomy: A comprehensive clinical review. Int J Crit Illn Inj Sci. 2015 Jul-Sep;5(3):160-9. doi: 10.4103/2229-5151.164939. PMID: 26557486; PMCID: PMC4613415.