The Impact Of Active Chest Tube Clearance Technology On Surgical Outcomes After Cardiac Surgery: An Updated Systematic Review And Meta-Analysis

Authors

  • Basil Ahmad Queen’s University School of Medicine, Kingston, ON, Canada https://orcid.org/0000-0003-1028-8960
  • Vithusha Yogathasan Queen’s University School of Medicine, Kingston, ON, Canada https://orcid.org/0000-0003-4281-1314
  • Eric Meng Queen’s University School of Medicine, Kingston, ON, Canada https://orcid.org/0000-0002-3392-0968
  • William Khoury Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada https://orcid.org/0000-0001-5236-0655
  • Ali M. Alakhtar Division of Cardiac Surgery, Department of Surgery, McGill University, Montreal, QC, Canada; Department of Surgery, Qassim University, Qassim, Kingdom of Saudi Arabia https://orcid.org/0000-0001-8326-3719
  • Angel-Luis Fernandez Cardiac Surgery Department, University Hospital, Santiago de Compostela, Spain
  • Mohammad El-Diasty Harrington Heart and Vascular Institute, Cardiac Surgery Department, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA https://orcid.org/0000-0002-1807-8397

DOI:

https://doi.org/10.48729/pjctvs.379

Keywords:

Cardiac Surgery, Active Clearance Technology, Mediastinal drains, Chest drains, Re-exploration, Postoperative bleeding

Abstract

Objective: Active chest tube clearance technology (ACT) systems were introduced to improve the patency of chest tubes and to reduce the potential complications associated with inadequate mediastinal blood drainage after cardiac surgical procedures. The purpose of this study is to assess the impact of ACT on the incidence of chest tube clogging, retained blood syndromes (RBS), re-exploration for bleeding, and the incidence of postoperative atrial fibrillation (POAF) after cardiac surgical procedures.
Methods: A database search was conducted using Medline, Embase, Cochrane Library, and Web of Science. Only articles comparing the use of ACT to conventional chest tube drainage after cardiac surgery were screened. Included articles were restricted to adult patients and English language only.
Results: Nine of the 841 articles screened were included in this review. Two studies were randomized controlled trials (RCT) and seven were observational studies. Pooled estimates showed RBS, surgical re-exploration rates, and POAF were significantly less common in the ACT group.
Conclusion: Our meta-analysis suggests that the use of ACT may be beneficial in reducing the incidence of postoperative complications associated with inadequate drainage of mediastinal blood after cardiac surgery. However, more robust evidence is required to endorse these findings and support the routing use of ACT in clinical practice.

Downloads

Download data is not yet available.

References

Al-Attar N, Johnston S, Jamous N, Mistry S, Ghosh E, Gangoli G, et al. Impact of bleeding complications on length of stay and critical care utilization in cardiac surgery patients in England. J Cardiothorac Surg. 2019 Apr 2;14(1):64.

Wallen MA, Morrison AL, Gillies D, O'Riordan E, Bridge C, Stoddart F. Mediastinal chest drain clearance for cardiac surgery. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD003042.

Labidi M, Baillot R, Dionne B, Lacasse Y, Maltais F, Boulet L-P. Pleural Effusions Following Cardiac Surgery: Prevalence, Risk Factors, and Clinical Features. CHEST. 2009 Dec 1;136(6):1604–11.

St-Onge S, Perrault LP, Demers P, Boyle EM, Gillinov AM, Cox J, et al. Pericardial Blood as a Trigger for Postoperative Atrial Fibrillation After Cardiac Surgery. Ann Thorac Surg. 2018 Jan 1;105(1):321–8.

Zisis C, Tsirgogianni K, Lazaridis G, Lampaki S, Baka S, Mpoukovinas I, et al. Chest drainage systems in use. Annals of Translational Medicine. 2015 Mar;3(3):15–15.

Barozzi L, Biagio LS, Meneguzzi M, Courvoisier DS, Walpoth BH, Faggian G. Novel, digital, chest drainage system in cardiac surgery. Journal of Cardiac Surgery. 2020;35(7):1492–7.

Karimov JH, Gillinov AM, Schenck L, Cook M, Kosty Sweeney D, Boyle EM, et al. Incidence of chest tube clogging after cardiac surgery: a single-centre prospective observational study. European Journal of Cardio-Thoracic Surgery. 2013 Dec 1;44(6):1029–36.

Tauriainen T, Kinnunen E-M, Koski-Vähälä J, Mosorin M-A, Airaksinen J, Biancari F. Outcome after procedures for retained blood syndrome in coronary surgery. Eur J Cardio-thorac Surg. 2017 Jun 1;51(6):1078–85.

Balzer F, Heymann C von, Boyle EM, Wernecke KD, Grubitzsch H, Sander M. Impact of retained blood requiring reintervention on outcomes after cardiac surgery. J Thorac Cardiovasc Surg. 2016 Aug 1;152(2):595-601.e4.

Sirch J, Ledwon M, Puski T, Boyle EM, Pfeiffer S, Fischlein T. Active clearance of chest drainage catheters reduces retained blood. J Thorac Cardiovasc Surg 2016;151:832-8 e1-2.

National Institute for Health and Care Excellence (NICE). (2017, October 16). PleuraFlow Active Clearance Technology for Maintaining Chest Tube Patency.

Engelman, D. T., Ben Ali, W., Williams, J. B., Perrault, L. P., Reddy, V. S., Arora, R. C., Roselli, E. E., Khoynezhad, A., Gerdisch, M., Levy, J. H., Lobdell, K., Fletcher, N., Kirsch, M., Nelson, G., Engelman, R. M., Gregory, A. J., & Boyle, E. M. (2019). Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery After Surgery Society Recommendations. JAMA surgery, 154(8), 755–766.

Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLOS Medicine. 2009 Jul 21;6(7): e1000097.

St-Onge S, Chauvette V, Hamad R, Bouchard D, Jeanmart H, Lamarche Y, et al. Active clearance vs conventional management of chest tubes after cardiac surgery: a randomized controlled study. Journal of Cardiothoracic Surgery. 2021 Mar 23;16(1):44.

Shalli S, Saeed D, Fukamachi K, Gillinov AM, Cohn WE, Perrault LP, et al. Chest Tube Selection in Cardiac and Thoracic Surgery: A Survey of Chest Tube-Related Complications and Their Management. J Card Surg. 2009;24(5):503–9.

Day TG, Perring RR, Gofton K. Is manipulation of mediastinal chest drains useful or harmful after cardiac surgery? Interactive CardioVascular and Thoracic Surgery. 2008 Oct 1;7(5):878–90.

Grieshaber P, Heim N, Herzberg M, Niemann B, Roth P, Boening A. Active Chest Tube Clearance After Cardiac Surgery Is Associated with Reduced Reexploration Rates. Ann Thorac Surg. 2018 Jun 1;105(6):1771–7.

Sirch J, Ledwon M, Püski T, Boyle EM, Pfeiffer S, Fischlein T. Active clearance of chest drainage catheters reduces retained blood. J Thorac Cardiovasc Surg. 2016 Mar;151(3):832-838.e2.

Maltais S, Davis ME, Haglund NA, Perrault L, Kushwaha SS, Stulak JM, et al. Active Clearance of Chest Tubes Reduces Re-Exploration for Bleeding After Ventricular Assist Device Implantation. Asaio Journal. 2016 Nov;62(6):704.

Baribeau Y, Westbrook B, Baribeau Y, Maltais S, Boyle EM, Perrault LP. Active clearance of chest tubes is associated with reduced postoperative complications and costs after cardiac surgery: a propensity matched analysis. J Cardiothorac Surg. 2019 Nov 8;14(1):192.

St-Onge S, Ben Ali W, Bouhout I, Bouchard D, Lamarche Y, Perrault LP, et al. Examining the impact of active clearance of chest drainage catheters on postoperative atrial fibrillation. J Thorac Cardiovasc Surg. 2017 Aug;154(2):501–8.

Malgerud L, Maret E, Reitan C, Ivert T. Active chest tube clearance after aortic valve surgery did not influence amount residual pericardial fluid after aortic valve replacement in a randomised trial. Scand Cardiovasc J. 2020 Jun;54(3):200–5.

St-Onge S, Bouhout I, Bouchard D, Carrier M, Cartier R, El-Hamamsy I, et al. Re-exploration and economic justification of a chest drainage protocol implementing active tube clearance after cardiac surgery. Canadian Journal of Cardiology. 2019 Oct 1;35(10): S189–90. 24. Salna M, Takayama H. Plight or Potential in Overengineering? Ann Thorac Surg. 2022 Oct;114(4):1340.

Downloads

Published

11-10-2023

How to Cite

1.
Ahmad B, Yogathasan V, Meng E, Khoury W, M. Alakhtar A, Fernandez A-L, El-Diasty M. The Impact Of Active Chest Tube Clearance Technology On Surgical Outcomes After Cardiac Surgery: An Updated Systematic Review And Meta-Analysis. Rev Port Cir Cardiotorac Vasc [Internet]. 2023 Oct. 11 [cited 2024 Nov. 21];30(3):43-5. Available from: https://pjctvs.com/index.php/journal/article/view/379

Issue

Vol. 30 No. 3 (2023): Jul-Sep

Section

Review Article

Categories

License

Copyright (c) 2023 Portuguese Journal of Cardiac Thoracic and Vascular Surgery

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Most read articles by the same author(s)