Relevant Publications

Thoracic Irrigation & CLR Use for Hemothorax Management

Retained hemothorax is common with standard chest drainage; frequently requires secondary interventions (e.g., lytics, VATS); and is associated with greater hospital length of stay and increased hospital costs. 

Prakash et al. (2020): In this 17-center study, 29% of patients with traumatic hemothorax developed retained hemothorax (ret. HTX) with standard management, 67% of these requiring secondary intervention. On average, patients with ret. HTX had 7 days longer hospital LOS, 3 days longer ICU LOS, increased ventilator days, and worse functional outcomes.

Zambetti et al. (2022): Patients requiring VATS for retained hemothorax had similarly long hospital LOS (14 days) and ICU LOS (4 days) as found by Prakash 2020.

Wong et al. (2022): Average increase in hospital costs associated with retained hemothorax management: lytics only $9,200, VATS only $10,700, open thoracotomy only $18,300. Costs higher if multiple interventions required.

Thoracic irrigation with CLR is associated with decreased odds of retained hemothorax requiring secondary intervention; fewer chest tube days; and zero safety events. 

Carver et al. (TBD): For CLR irrigated patients, the odds of requiring a secondary intervention for retained hemothorax (e.g., VATS) was 80% lower than non-irrigated patients (Odds Ratio 0.20, p<0.001). CLR irrigated patients required 2 fewer chest tube days. Over 100 patients irrigated with CLR with zero safety events (e.g., no increased bleeding, no increased empyema).

Thoracic irrigation for hemothorax management is guideline-supported and associated with a decreased rate of retained hemothorax requiring secondary intervention, shorter hospital length of stay, and lower hospital charges.  

Kugler et al. (2017): Thoracic irrigation associated with lower rate of secondary intervention (e.g., second chest tube, operative management) for retained hemothorax: 5.6% vs. 21.8% for standard therapy patients (p<0.001). No difference in thoracic infections.

Crankshaw et al (2022): Thoracic irrigation associated with 4 fewer hospital days than standard therapy (p = 0.04). When irrigated with >1000cc, patients stayed in hospital for 8 fewer days (p=0.002). Hospital charges an average of $88,000 lower in irrigated patients (p=0.02). No difference in thoracic infections.

Western Trauma Association: Thoracic irrigation is incorporated in the WTA’s hemothorax management algorithm.

Disclaimer: The studies depicted above should not be interpreted as an endorsement of CLR device use for a specific clinical indication, use case, or clinical protocol, or as a claim of a specific clinical outcome. Use of CLR devices must always be guided by clinical judgement per the indications for use.