Comparison of three different chest drainages after coronary artery bypass surgery--a randomised trial in 150 patients.

Objective: Drainage of blood from the mediastinum and pleura following open cardiac procedures is usually carried out using one or more large-bore plastic chest tubes. Recently small diameter siliastic drains have been reported to evacuate blood with a better patient comfort. The efficacy and safety of different chest tubes have not yet been fully evaluated.

Methods: One hundred fifty patients undergoing coronary artery bypass surgery were randomised to have either Blake) 24F (Ethicon, Inc, Somerville, NJ), Argyle 32F plastic (Tyco Healthcare, Tullamore, UK) or Jostra 32F silastic (Maquet Cardiopulmonary AG, Hirrlingen, Germany) drains inserted for evacuation of postoperative bleeding. Bleeding rate per hour, total blood loss, patient discomfort during drain removal, residual pleural fluid at chest X-ray 3 days and 3 weeks after the operation were recorded.

Results: Bleeding pattern and total bleeding did not differ significantly in the three groups. Median blood loss was 615 ml (quartile range 390-820 ml) in the Blake-group, 750 ml (quartile range 430-870 ml) in the Jostra-group and 580 ml (quartile range 450-750 ml) in the Argyle-group, respectively (p=0.17). Pain at removal the day after the operation was similar in the three groups. Residual fluid in the left pleura did not differ significantly at 3 days (p=0.41) or at 3 weeks postoperatively (p=0.42).

Conclusions: None of the three chest tubes was superior to drain postoperative bleeding or considering pain at removal. Local clinical routines and cost aspects should be the guide in choosing drainage system for open cardiac operations.