Page 43 - JSOM Winter 2022

Comparing a Novel Hand-Held Device for
Chest Tube Insertion to the Traditional Open Tube Thoracostomy
for Simple Pneumothorax in a Porcine Model

Joshua Dilday, DO *; Bethany Heidenreich , DO; Holly Spitzer, DO ;
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Yousef Abuhakmeh , DO; Eric Ahnfeldt, DO ; John Watt, MD ; Vincent J. Mase Jr, MD 7
ABSTRACT
Background: Tube thoracostomy is the most effective treat- rate of up to 28%. Most chest tube complications are inser-
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ment for pneumothorax, and on the battlefield, is lifesaving. tional, positional, or infectious. Positional complications are
In combat, far-forward adoption of open thoracostomy has most common, with highest rate of malposition (31%) occur-
not been successful. Therefore, the ability to safely and reliably ring in the emergency department setting. Traditional tho-
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perform chest tube insertion in the far-forward combat the- racostomy insertion is associated with increased complications
atre would be of significant value. The Reactor is a hand-held in inexperienced hands. Traditional tube thoracostomy place-
device for tube thoracostomy that has been validated for ten- ment can also be cumbersome, slow, and resource dependent.
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sion pneumothorax compared to needle decompression. Here Therefore it has not been adopted into the practice of prehos-
we investigate whether the Reactor has potential for simple pital providers. Instead, temporizing measures, like needle de-
pneumothorax compared to open thoracostomy. Treatment compression, have predominated prehospital management of
of pneumothorax before tension physiology ensues is critical. pneumothorax. Benefits of needle decompression include rela-
Methods: Simple pneumothoraces were created in 5 in-vivo tive ease and speed, minimal resources, and familiarity. How-
swine models and confirmed with x-ray. Interventions were ever, needle decompression is largely ineffective, particularly
randomized to open technique (OT, n = 25) and Reactor (RT, in combat, with failure rates as high as 58%. The inefficient
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n = 25). Post-procedure radiography was used to confirm tube technique of traditional tube thoracostomy, paired with the
placement and pneumothorax resolution. Video Assisted Tho- ineffectiveness of needle decompression, create the necessity
racoscopic Surgery (VATS) was used to evaluate for iatrogenic for a new technique that is both effective and appropriate for
injuries. 50 chest tubes were placed, with 25 per group. Re- prehospital application.
sults: There were no statistical differences between the groups
for insertion time, pneumothorax resolution, or estimated Numerous alternative methods of tube thoracostomy have
blood loss (p = .91 and .83). Injury rates between groups var- been described, like blunt dissection, percutaneous placement,
ied, with 28% (n = 7) in the Reactor group and 8% (n = 2) the and trocar placement. Each method has risks and complica-
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control group (p = .06). The most common injury was viola- tions. To optimally place a functioning chest tube, with mini-
tion of visceral pleura (10%, n = 5, both groups) and violation mal insertional or positional complications, a well-defined and
of the mediastinum (8%, n = 4, both groups). Conclusion: The oriented tract must be created through the chest wall. The Re-
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Reactor device was equal compared to open thoracostomy actor (Sharp Medical Products, https://www.medalliancegroup.
for insertion time, pneumothorax resolution, and injury rates. com/product/reactor-sharp-medical-products/) is a US Food &
The device required smaller incisions compared to tube tho- Drug Administration (FDA) approved chest tube insertion de-

racostomy and may be useful adjunct in simple pneumothorax vice that creates a tract for tube thoracostomy using a blunt
management. bladed trocar (Figure 1). It has been shown to be effective in
tension pneumothorax compared to needle decompression. 10
Keywords: chest tube; thoracostomy; pneumothorax
The purpose of this study is to evaluate the effectiveness and
safety of the Reactor thoracostomy device compared to tradi-

tional open thoracostomy for management of simple pneumo-
Background
thorax. We hypothesize that utilization of the Reactor for tube

Pneumothorax is the most common life-threatening injury in thoracostomy (RT), will result in faster thoracic decompres-
blunt thoracic trauma and occurs in approximately 20–40% sion, smaller incisions, and less iatrogenic trauma versus open
of all blunt trauma. Continued accumulation of air in the thoracostomy (OT).
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pleural space can increase intrapleural pressure, compressing
mediastinal structures and leading to obstructive shock and, Methods
if not relieved, death. Definitive treatment and the gold stan-
dard for management of pneumothorax is tube thoracostomy. Study approval was obtained from the local Institutional An-
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However, despite being one of the most commonly performed imal Care and Use Committee (IACUC). The study was per-
procedures, tube thoracostomy carries an overall complication formed in adherence to laboratory animal use guidelines of the
*Correspondence to Joshua.C.Dilday@gmail.com
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1 Joshua Dilday, Bethany Heidenreich, Holly Spitzer, Yousef Abuhakmeh, and Eric Ahnfeldt are physicians affiliated with the William Beau-
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mont Army Medical Center, El Paso, TX. John Watt is a physician affiliated with Chandler Regional Medical Center, Chandler, AZ. Vincent J.
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Mase Jr is a physician affiliated with the Yale University Medical Center, New Haven, CT.
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