The Influence of Dynamically Regulated, Intermittently Regulated Active Chest Drainage Units Compared to Conventional Vacuum-Driven Systems on the Early Postoperative Outcome after Cardiac Surgery

Currently, the use of active chest drainage units (CDU) has become more and more common in cardiac surgery. Since CDU operate on different principles, we compared the influence of dynamically regulated, intermittently regulated and conventional vacuum-driven CDUs on the early postoperative outcome after cardiac surgery.

A retrospective review revealed 144 consecutive patients who underwent cardiac surgery at our institution. Patients were divided into three groups based on the type of CDU. The first group consisted of patients who received an electrically-driven digital CDU which dynamically regulates the level of suction (Atmos, Thorax C051/S201, n = 26). The second group received an electrically-driven digital CDU which intermittently regulates the level of suction (Medela, Thopaz+, n = 68). The third group of patients received a conventional vacuum-driven analog CDU (Covidien, Sentinel Seal®, n = 50). In addition to baseline parameters and operative details, the amount of postoperative blood loss and the presence of air leaks have been documented. Coagulation parameters have been analyzed as well as technical and user-dependent adverse events.

Median age was 70 years (p = 0.72) and median EuroSCORE II was 3.6% (p = 0.40). There was no significant difference concerning the intake of antiplatelet drugs, dual antiplatelet therapy, triple antiplatelet therapy and New Oral Anticoagulants (p = 0.24, 0.74, 0.39 and 0.29, respectively). However, the use of vitamin K antagonists differed between the groups (p = 0.05). There was no difference in pre- and postoperative coagulation parameters nor was there a difference in postoperative blood loss (p = 0.25) during the first 24 hours. The rate of re-explorative surgery was 1.4% and did not differ between the groups (p = 0.78).

The presented study indicates that active CDU systems can be safely and effectively applied in patients after cardiac surgery. Due to the improved patient mobility and simplified chest tube management the use of active CDU systems may thus be advantageous for this group of patients.