Closed-tube Thoracostomy

Nasr, Mohamed Mahmood

doi:10.1097/sle.0000000000000028

Cited by 1 publication

(1 citation statement)

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“…Furthermore, Kuckelman et al showed that the Reactor™ was significantly more successful at achieving rapid and complete resolution of tension pneumothorax compared to needle decompression (88% vs. 44%, P < 0.001) in a post-mortem swine model. Laparoscopic-type trocar procedures have been reported in two human case series for the treatment of simple pneumothoraces in which a chest tube is subsequently inserted through the trocar [4, 5]. Nevertheless, tube thoracostomy using a trocar-type device or the Reactor™ has not yet been compared with the standard, open technique.…”

Section: Discussionmentioning

confidence: 99%

Comparison of a novel, endoscopic chest tube insertion technique versus the standard, open technique performed by novice users in a human cadaver model: a randomized, crossover, assessor-blinded study

Drumheller

Basel

Adnan

et al. 2018

Scand J Trauma Resusc Emerg Med

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BackgroundThe technique of tube thoracostomy has been standardized for years without significant updates. Alternative procedural methods may be beneficial in certain prehospital and inpatient environments with limited resources. We sought to compare the efficacy of chest tube insertion using a novel, endoscopic device (The Reactor™) to standard, open tube thoracostomy.MethodsNovice users were randomly assigned to pre-specified sequences of six chest tube insertions performed on a human cadaver model in a crossover design, alternating between the Reactor™ and standard technique. All subjects received standardized training in both procedures prior to randomization. Insertion site, which was randomly assigned within each cadaver’s hemithorax, was marked by the investigators; study techniques began with skin incision and ended with tube insertion. Adequacy of tube placement (intrapleural, unkinked, not in fissure) and incision length were recorded by investigators blinded to procedural technique. Insertion time and user-rated difficulty were documented in an unblinded fashion. After completing the study, participants rated various aspects of use of the Reactor™ compared to the standard technique in a survey evaluation.ResultsSixteen subjects were enrolled (7 medical students, 9 paramedics) and performed 92 chest tube insertions (n = 46 Reactor™, n = 46 standard). The Reactor™ was associated with less frequent appropriate tube positioning (41.3% vs. 73.9%, P = 0.0029), a faster median insertion time (47.3 s, interquartile range 38–63.1 vs. 76.9 s, interquartile range 55.3–106.9, P < 0.0001) and shorter median incision length (28 mm, interquartile range 23–30 vs. 32 mm, interquartile range 26–40, P = 0.0034) compared to the standard technique. Using a 10-point Likert scale (1-easiest, 10-hardest) participants rated the ease of use of the Reactor™ no different from the standard method (3.8 ± 1.9 vs. 4.7 ± 1.9, P = 0.024). The Reactor™ received generally favorable scores for all parameters on the post-participation survey.ConclusionsIn this randomized, assessor-blinded, crossover human cadaver study, chest tube insertion using the Reactor™ device resulted in faster insertion time and shorter incision length, but less frequent appropriate tube placement compared with the standard technique. Additional studies are needed to evaluate the efficacy, safety and potential advantages of this novel device.

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Section: Discussionmentioning

confidence: 99%