Needle aspiration for treating iatrogenic pneumothorax after cardiac electronic device implantation: a pilot study

Dominika Domokos, Andras Szabo, Gyongyver Banhegyi, Balazs Polgar, Zsolt Bari, Peter Bogyi, Istvan Marczell, Leticia Papp, R. Kiss, G. Duray, B. Merkely, Istvan Hizoh

Research output: Contribution to journalArticle

Abstract

Purpose: Pneumothorax (PTX) following cardiac implantable electronic device procedures is traditionally treated with chest tube drainage (CTD). We hypothesized that, in a subset of patients, the less invasive needle aspiration (NA) may also be effective. We compared the strategy of primary NA with that of primary CTD in a single-center observational study. Methods: Of the 970 procedures with subclavian venous access between January 2016 and June 2018, 23 patients had PTX requiring intervention. Beginning with March 2017, the traditional primary CTD (9 cases) has been replaced by the “NA first” strategy (14 patients). Outcome measures were procedural success rate and duration of hospitalization evaluated both as time to event (log-rank test) and as a discrete variable (Wilcoxon-Mann-Whitney test). Results: Needle aspiration was successful in 8/14 (57.1%) of the cases (95% CI 28.9–82.3%), whereas PTX resolved in all patients after CTD was 9/9 (100%, 95% CI 66.4–100.0%, p = 0.0481). Regarding length of hospital stay, intention to treat time to event analysis showed no difference between the two approaches (p = 0.73). Also, the median difference was not statistically significant (− 2.0 days, p = 0.17). In contrast, per protocol evaluation revealed reduced risk of prolonged hospitalization for NA patients (p = 0.0025) with a median difference of − 4.0 days (p = 0.0012). Failure of NA did not result in a meaningful delay in discharge timing as median difference was 1.5 days (p = 0.28). Conclusions: Our data suggest that in a number of patients iatrogenic PTX may be successfully treated with NA resulting in shorter hospitalization without the risk of meaningful discharge delay in unsuccessful cases.

Original languageEnglish
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Pneumothorax
Needles
Chest Tubes
Equipment and Supplies
Drainage
Hospitalization
Length of Stay
Aspirations (Psychology)
Observational Studies
Outcome Assessment (Health Care)

Keywords

  • Cardiac implantable electronic device
  • Chest tube drainage
  • Complication
  • Needle aspiration
  • Pneumothorax

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Needle aspiration for treating iatrogenic pneumothorax after cardiac electronic device implantation : a pilot study. / Domokos, Dominika; Szabo, Andras; Banhegyi, Gyongyver; Polgar, Balazs; Bari, Zsolt; Bogyi, Peter; Marczell, Istvan; Papp, Leticia; Kiss, R.; Duray, G.; Merkely, B.; Hizoh, Istvan.

In: Journal of Interventional Cardiac Electrophysiology, 01.01.2019.

Research output: Contribution to journalArticle

Domokos, Dominika ; Szabo, Andras ; Banhegyi, Gyongyver ; Polgar, Balazs ; Bari, Zsolt ; Bogyi, Peter ; Marczell, Istvan ; Papp, Leticia ; Kiss, R. ; Duray, G. ; Merkely, B. ; Hizoh, Istvan. / Needle aspiration for treating iatrogenic pneumothorax after cardiac electronic device implantation : a pilot study. In: Journal of Interventional Cardiac Electrophysiology. 2019.
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abstract = "Purpose: Pneumothorax (PTX) following cardiac implantable electronic device procedures is traditionally treated with chest tube drainage (CTD). We hypothesized that, in a subset of patients, the less invasive needle aspiration (NA) may also be effective. We compared the strategy of primary NA with that of primary CTD in a single-center observational study. Methods: Of the 970 procedures with subclavian venous access between January 2016 and June 2018, 23 patients had PTX requiring intervention. Beginning with March 2017, the traditional primary CTD (9 cases) has been replaced by the “NA first” strategy (14 patients). Outcome measures were procedural success rate and duration of hospitalization evaluated both as time to event (log-rank test) and as a discrete variable (Wilcoxon-Mann-Whitney test). Results: Needle aspiration was successful in 8/14 (57.1{\%}) of the cases (95{\%} CI 28.9–82.3{\%}), whereas PTX resolved in all patients after CTD was 9/9 (100{\%}, 95{\%} CI 66.4–100.0{\%}, p = 0.0481). Regarding length of hospital stay, intention to treat time to event analysis showed no difference between the two approaches (p = 0.73). Also, the median difference was not statistically significant (− 2.0 days, p = 0.17). In contrast, per protocol evaluation revealed reduced risk of prolonged hospitalization for NA patients (p = 0.0025) with a median difference of − 4.0 days (p = 0.0012). Failure of NA did not result in a meaningful delay in discharge timing as median difference was 1.5 days (p = 0.28). Conclusions: Our data suggest that in a number of patients iatrogenic PTX may be successfully treated with NA resulting in shorter hospitalization without the risk of meaningful discharge delay in unsuccessful cases.",
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author = "Dominika Domokos and Andras Szabo and Gyongyver Banhegyi and Balazs Polgar and Zsolt Bari and Peter Bogyi and Istvan Marczell and Leticia Papp and R. Kiss and G. Duray and B. Merkely and Istvan Hizoh",
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T1 - Needle aspiration for treating iatrogenic pneumothorax after cardiac electronic device implantation

T2 - a pilot study

AU - Domokos, Dominika

AU - Szabo, Andras

AU - Banhegyi, Gyongyver

AU - Polgar, Balazs

AU - Bari, Zsolt

AU - Bogyi, Peter

AU - Marczell, Istvan

AU - Papp, Leticia

AU - Kiss, R.

AU - Duray, G.

AU - Merkely, B.

AU - Hizoh, Istvan

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: Pneumothorax (PTX) following cardiac implantable electronic device procedures is traditionally treated with chest tube drainage (CTD). We hypothesized that, in a subset of patients, the less invasive needle aspiration (NA) may also be effective. We compared the strategy of primary NA with that of primary CTD in a single-center observational study. Methods: Of the 970 procedures with subclavian venous access between January 2016 and June 2018, 23 patients had PTX requiring intervention. Beginning with March 2017, the traditional primary CTD (9 cases) has been replaced by the “NA first” strategy (14 patients). Outcome measures were procedural success rate and duration of hospitalization evaluated both as time to event (log-rank test) and as a discrete variable (Wilcoxon-Mann-Whitney test). Results: Needle aspiration was successful in 8/14 (57.1%) of the cases (95% CI 28.9–82.3%), whereas PTX resolved in all patients after CTD was 9/9 (100%, 95% CI 66.4–100.0%, p = 0.0481). Regarding length of hospital stay, intention to treat time to event analysis showed no difference between the two approaches (p = 0.73). Also, the median difference was not statistically significant (− 2.0 days, p = 0.17). In contrast, per protocol evaluation revealed reduced risk of prolonged hospitalization for NA patients (p = 0.0025) with a median difference of − 4.0 days (p = 0.0012). Failure of NA did not result in a meaningful delay in discharge timing as median difference was 1.5 days (p = 0.28). Conclusions: Our data suggest that in a number of patients iatrogenic PTX may be successfully treated with NA resulting in shorter hospitalization without the risk of meaningful discharge delay in unsuccessful cases.

AB - Purpose: Pneumothorax (PTX) following cardiac implantable electronic device procedures is traditionally treated with chest tube drainage (CTD). We hypothesized that, in a subset of patients, the less invasive needle aspiration (NA) may also be effective. We compared the strategy of primary NA with that of primary CTD in a single-center observational study. Methods: Of the 970 procedures with subclavian venous access between January 2016 and June 2018, 23 patients had PTX requiring intervention. Beginning with March 2017, the traditional primary CTD (9 cases) has been replaced by the “NA first” strategy (14 patients). Outcome measures were procedural success rate and duration of hospitalization evaluated both as time to event (log-rank test) and as a discrete variable (Wilcoxon-Mann-Whitney test). Results: Needle aspiration was successful in 8/14 (57.1%) of the cases (95% CI 28.9–82.3%), whereas PTX resolved in all patients after CTD was 9/9 (100%, 95% CI 66.4–100.0%, p = 0.0481). Regarding length of hospital stay, intention to treat time to event analysis showed no difference between the two approaches (p = 0.73). Also, the median difference was not statistically significant (− 2.0 days, p = 0.17). In contrast, per protocol evaluation revealed reduced risk of prolonged hospitalization for NA patients (p = 0.0025) with a median difference of − 4.0 days (p = 0.0012). Failure of NA did not result in a meaningful delay in discharge timing as median difference was 1.5 days (p = 0.28). Conclusions: Our data suggest that in a number of patients iatrogenic PTX may be successfully treated with NA resulting in shorter hospitalization without the risk of meaningful discharge delay in unsuccessful cases.

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KW - Chest tube drainage

KW - Complication

KW - Needle aspiration

KW - Pneumothorax

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