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in far forward setting would need to be addressed. Although 8. Mao M, Hughes R, Papadimos TJ, Stawicki SP. Complications
not considered in this study; multiple firings and mis-firings of chest tubes: a focused clinical synopsis. Curr Opin Pulm Med.
occurred with the Reactor, requiring further evaluation. The 2015;21(4):376–386.
silastic sheath through which the chest tube is inserted is stiff, 9. Kwiatt M, Tarbox A, Seamon MJ, et al. Thoracostomy tubes: a
comprehensive review of complications and related topics. Int J
possibly altering the ability to direct the tube to a desired Crit Illn Inj Sci. 2014;4(2):143–155.
position. 10. Kuckelman J, Derickson M, Phillips C, et al. Evaluation of a novel
thoracic entry device versus needle decompression in a tension
The avoidance of progression to tension physiology is vitally pneumothorax swine model. Am J Surg. 2018;215(5):832–835.
important. In 2011, 318 combat casualties were evaluated 11. Joint Trauma System. Tactical Combat Casualty Care guidelines.
for fatality rate and causes of survivable death. The cause of https://jts.health.mil/index.cfm/committees/cotccc/guidelines. Ac-
cessed 5 August 2022.
preventable death in 20% was failed prehospital thoracic de- 12. Barie PS. Surgical infections and antibiotic use. In: Townsend
compression. Therefore, effective thoracic decompression CM, Evers BM, Beauchamp RD, Mattox KL, eds. Sabiston text-
15
remains a priority in current Tactical Combat Casualty Care book of surgery. Philadelphia, PA: Elsevier; 2020:241–280.
Guidelines. The Reactor is non-inferior for this purpose. 13. Munnell, ER. Chest drainage in the traumatized patient. In: Webb
11
Additionally, the Reactor is lightweight (less than 200 g) and WR, Besson A, eds. Thoracic surgery: Surgical management of chest
consolidated with a blade, pleural entry device, and sleeve con- injuries. St. Louis, MI: Mosby-Year Book, Inc; 1991:219–228.
tained in a single device. Comparatively, the open technique re- 14. Drumheller BC, Basel A, Adnan S, et al. Comparison of a novel,
endoscopic chest tube insertion technique versus the standard,
quires multiple instruments, requiring kits of variable contents open technique performed by novice users in a human cadaver
and weights. model: a randomized, crossover, assessor-blinded study. Scand J
Trauma Resusc Emerg Med. 2018;26(1):110.
15. Gerhardt RT, Berry JA, Blackbourne LH. Analysis of life-saving
Conclusion interventions performed by out-of-hospital combat medical per-
sonnel. J Trauma. 2011;71(1 Suppl):S109–S113.
This study demonstrates non-inferiority of the Reactor com-

pared to open thoracostomy, lending support to potential util-
ity of this device in expanding pre-hospital management of
pneumothorax. Given the non-inferiority of this device, com-
pared to the traditional approach, with consideration of ease,
portability, safety, and effectiveness, this device has potential
for forward deployment and utilization in austere environ-
ments. Further evaluation is needed in the future.

Disclosure
The authors do not have any conflicting financial interests to
disclose.
Disclaimer
The views expressed in this article are those of the author(s)
and do not reflect the official policy of the Department of
Army, Department of Defense, or US Government.

Author Contributions
JD, BH, and VM contributed to literature search, study design,
data collection, data analysis, data interpretation, writing, and
critical revision. HS, YA, EA, and JW contributed to literature
search, writing, critical revision.

References
1. Dogrul BN, Kiliccalan I, Asci ES, Peker SC. Blunt trauma related
chest wall and pulmonary injuries: an overview. Chin J Traumatol.
2020;23(3):125–138.
2. Huber-Wagner S, Körner M, Ehrt A, et al. Emergency chest tube
placement in trauma care - which approach is preferable? Resusci-
tation. 2007;72(2):226–233.
3. Agarwal S, Raptis C, Bhalla S. Imaging of thoracic trauma. In:
Digumarthy SR, ed. Problem solving in chest imaging. Philadel-
phia, PA: Russell Gabbedy; 2020:668–676.
4. Rottenstreich M, Fay S, Gendler S, Klein Y, et al. Needle thoracot-
omy in trauma. Mil Med. 2015;180(12):1211.
5. Ball CG, Lord J, Laupland KB, Gmora S, et al. Chest tube com-
plications: how well are we training our residents? Can J Surg.
2007;50(6):450–458.
6. Aylwin CJ, Brohi K, Davies GD, Walsh MS. Pre-hospital and
in-hospital thoracostomy: indications and complications. Ann R
Coll Surg Engl. 2008;90(1):54–57.
7. Kuhajda I, Zarogoulidis K, Kougioumtzi I, et al. Tube thoracos-
tomy; chest tube implantation and follow up. J Thorac Dis. 2014;
6(Suppl 4):S470–S479.

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