Overall, according to pooled data, complications are rare.2,5–7 A pneumothorax is the most common complication, especially with the parasternal approach. Other reported complications include coronary artery laceration, myocardial laceration, hemopericardium, cardiac tamponade, pulmonary artery laceration, and perforation of the stomach or liver. Intramyocardial injection has been reported and is associated with intractable ventricular fibrillation. Identification of the appropriate anatomic landmarks for needle insertion and direction can minimize complications. Careful adherence to proper technique can also minimize complications. The use of a small-gauge spinal needle and the subxiphoid approach may result in fewer complications versus a large-gauge needle and the left parasternal approach.8