Active Chest Tube Clearance Added to an Enhanced Recovery After Cardiac Surgery (ERAS) Program Improves Outcomes and Reduces Resource Utilization

Wednesday, July 16, 2025

Submitted by

Mujtaba Mubashir

Source

Source Name: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery

Source URL: https://journals.sagepub.com/doi/abs/10.1177/15569845251326084

Author(s)

Marc W. Gerdisch, Chanice Johns, Manesh Parikshak, Andrew Barksdale, Louis P. Perrault

This article describes the outcomes of adding active chest tube clearance (ATC) to enhanced recovery after cardiac surgery (ERAS) program, comparing 684 patients who underwent ATC compared to 650 patients who did not. The authors noted a 41 percent reduction in retained blood (ATC group: 8.2 percent vs non-ATC group: 4.8 percent, p<0.05), a decrease in postoperative atrial fibrillation (ATC group: 28 percent vs non-ATC group: 33 percent, p<0.05), and a statistically significant reduction in median ICU hours. This improvement was attributed to the known high incidence of clogging in chest tubes, which was improved with active chest tube clearance. The authors also correlated their outcomes with favorable improvements in resource utilization and cost savings.

Comments

Submitted by Edward Savage on Thu, 2025-07-24 07:12

This article has several limitations, some referenced by the authors including no blinding and randomization. This sequential study cannot account for the impact of improved application of ERAS protocols over time. A concurrent (though not blinded) study published from Northwestern (Ann Thorac Surg. 2022 Oct;114(4):1334-1340. doi: 10.1016/j.athoracsur.2022.02.086. Epub 2022 Apr 11.) directly contradicts the findings of this study, demonstrating no benefit from the device. I don't dispute that there is value to ensuring chest tube patency. Prior to the introduction of this expensive device, we used mechanical stripping and chest tube aspiration with an endotracheal tube suction catheter. In some ERAS publications reference is made to the ills of stripping. I drilled down on the references used to support this statement. All referenced an article that suggested that high negative pressure generated was bad, with no evidence to support that assertion. The theoretical disadvantage of chest tube aspiration is breaking the sterile field. If done carefully, sterility can be maintained. This theoretical disadvantage has never been proven to increase the risk of mediastinitis. Though the study reports no financial support for the study. One of the authors has received significant financial remuneration from the company which is unreported. My personal opinion, and I acknowledge it is my opinion, is that despite the reported findings of this study, the use of this expensive device is not of proven value.