Chest Tube Clearance Strategies Versus Conventional Chest Tubes After Cardiac Surgery

Abstract

Standard chest tubes (CTs) used to drain retained blood can become occluded from blood clots, leading to ineffective drainage and postoperative complications such as cardiac tamponade. Chest tube clearance strategies (CTCSs) were developed to improve CT patency. Our meta-analysis compared the safety and efficacy of CTCS versus CT following cardiac surgery. The PubMed/MEDLINE, Embase, Web of Science, and Scopus databases were searched from 1946 to 2023 for studies that compared CTCS to CT. Two investigators independently reviewed, screened, extracted, and assessed the data prior to performing a random effects meta-analysis using R. The primary outcome was re-exploration and the secondary outcomes were retained blood syndrome, mortality, blood products, stroke, cardiac arrest, atrial fibrillation, ventilation time, intensive care unit (ICU) time, hospital length of stay, and chest drainage. Five studies (2288 patients) were included. There were two clinical trials (n = 620) and three observational studies (1668 patients). Compared to CT, CTCS had a significant reduction of postoperative atrial fibrillation (risk ratio (RR) 0.80, 95% CI 0.70 to 0.92, I² = 17%, p < 0.01). There was no significant difference in re-exploration, retained blood syndrome, hospital length of stay, and ICU length of stay. However, with the addition of four unmatched studies (n = 2583), CTCS was associated with a significant reduction in re-exploration (RR 0.52, 95% CI 0.37 to 0.73, I² = 34%, p < 0.01), retained blood syndrome (RR 0.71, 95% CI 0.53 to 0.95, I² = 72%, p = 0.02), hospital length of stay (mean difference (MD) −0.40, 95% CI −0.78 to −0.01, I² = 49%, p = 0.04), and chest drainage (MD 0.80, 95% CI 0.70 to 0.92, I² = 17%, p < 0.01). Drawing from results including the unmatched studies, CTCSs are associated with fewer postoperative complications compared to CT. This was achieved without major differences in chest drainage, supporting the important role of preventing even small accumulations of blood in the pericardial space.