Efficacy of a novel steerable chest tube system in a swine model of hemothorax.

Thoracostomy tubes (chest tubes) are the standard of care for thoracic trauma, including hemothorax. However, traditional chest tubes are susceptible to occlusion and lack the ability to be repositioned once inserted. This can lead to further life-threatening issues, such as retained hemothorax. Here we describe the investigation of a novel steerable chest tube, the SAM repositionable chest tube (RCT), which is designed with two-axis manipulation for effective drainage of the pleural space while maintaining sterility. We hypothesized that the treatment of hemothorax with RCT would result in an increase of evacuated fluid from the pleural space and a decrease of residual clot compared to a traditional chest tube. Using a swine model of retained hemothorax developed by our laboratory, six male swine (78.2±2.1 kg) were randomized for an RCT and traditional (straight 28-Fr chest tube) side of the pleural cavity. To create a hemothorax, 2 L of autologous blood was withdrawn and 1 L was infused into each side of the pleural cavity. Evacuated blood volume was recorded for both devices for the entirety of the experiment, and residual clot was measured upon necropsy. At end of study, the RCT demonstrated significantly greater blood evacuation (585±65 mL) compared to the traditional chest tube (436±100 mL, P=0.03). Although the RCT reduced retained clot burden (436±95 vs. 571±75 g), the difference was not statistically significant (P=0.054). There were no cardiac, pulmonary, or diaphragmatic injuries that were observed due to chest tube placement. The RCT consistently outperformed a traditional chest tube in drainage volume over time.