Active clearance chest tubes: Awaiting randomized data

Abstract

Anaheim, Calif) is a commercially available chest tube that contains a guidewire-based clearance mechanism to maintain chest tube patency. To date, retrospective studies have shown that ATC chest tubes may reduce bleeding complications after heart surgery in certain patient populations. 1-3 A secondary benefit uncovered in previous study was a reduced rate of postoperative atrial fibrillation (POAF) with use of ATC chest tubes, thought to be related to reduced atrial irritation from improved mediastinal drainage. 1 In the current issue of the Journal, St-Onge and colleagues 4 from The Montreal Heart Institute performed a retrospective analysis of ATC chest tube use at their institution during a 3-month period, with a primary aim of assessing for reduced POAF. In an unadjusted analysis, there was an encouraging 34% reduction in POAF in patients managed with ATC chest tubes relative to conventional chest tubes. Attempts at risk-adjustment yielded mixed results, however; reduced POAF associated with ATC chest tubes was reproduced in a multivariable model but not in a propensity-matched subgroup analysis.The study by St-Onge and colleagues 4 contains many limitations that are appropriately acknowledged in the article, including small sample size, lack of standardized POAF prophylaxis, and unbalanced patient characteristics and procedural complexity between groups due to a lack of randomization. In addition, the study protocol did not allow for stripping of the conventional chest tubes, which is a ubiquitous nursing practice at most institutions (whether one chooses to publicly admit it or not). As a result, the study may not have achieved a ''real-world'' comparison between ATC and conventional chest tubes.Perhaps more notable is that ATC chest tubes were not associated with improved mediastinal drainage over conventional chest tubes, as evidenced by equivalent chest tube output, transfusions, and interventions for intrathoracic fluid removal between groups. In response to this somewhat perplexing finding, St-Onge and colleagues 4 hypothesized that a faster rate of drainage from an unobstructed tube may

Incidence and Outcomes of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting of a Randomized Controlled Trial: A Blinded End-of-cycle Analysis

“…[ 85 ] who found a link between new onset atrial fibrillation and pleural effusion. Similarly, Anderson [ 86 ] also showed that self-clearing chest tubes may reduce POAF although a randomized data is still needed to prove this claim. Interestingly a systematic review by Gozdek et al .…”

“…This is consistent with the finding by Brookes et al [85] who found a link between new onset atrial fibrillation and pleural effusion. Similarly, Anderson [86] also showed that selfclearing chest tubes may reduce POAF although a randomized data is still needed to prove this claim. Interestingly a systematic review by Gozdek et al [87] showed that posterior pericardial drainage to minimize any possibility of pericardial tamponade could reduce the odds of POAF by 58% indicating that POAF is possibly associated with pericar-dial collections.…”