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Mohammed NA, Al-Zubairi TA, Al-Soumai MH. A case report on ultrasound-guided pericardiocentesis with a right parasternal approach: a novel in-plane lateral-to-medial technique. Int J Emerg Med 2024; 17:15. [PMID: 38302868 PMCID: PMC10835824 DOI: 10.1186/s12245-024-00592-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/26/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Emergency pericardiocentesis is a life-saving procedure that is performed to aspirate fluid from the pericardial space in patients who have severe pericardial effusion that is causing hemodynamic compromise. The current gold standard for pericardial fluid aspiration is ultrasound-guided pericardiocentesis. Echocardiography with a low-frequency transducer has generally been used in pericardiocentesis, but this method lacks real-time visualization of the needle trajectory, leading to complications. Therefore, we describe a case involving an ultrasound-guided pericardiocentesis method using a novel in-plane technique with a lateral-to-medial approach via the right parasternal and a high-frequency probe. The method was performed for an infant with cardiac tamponade. CASE PRESENTATION We present a case of a 14-month-old male infant who was brought to the emergency room with a history of cough, shortness of breath, and fever following recurrent chest infections. Despite prior treatments, his condition deteriorated, and signs of cardiac tamponade were evident upon examination. Cardiopulmonary point-of-care ultrasound confirmed the presence of a large pericardial effusion with tamponade. Emergency pericardiocentesis was performed using the novel in-plane technique, resulting in successful fluid aspiration and stabilization of the patient's condition. TECHNIQUE DESCRIPTION The proposed technique involves positioning a high-frequency ultrasound probe over the right parasternal area to obtain real-time visualization of the needle trajectory and surrounding structures, including the sternum, right internal thoracic vessels, pleural sliding end point, pericardial effusion, and myocardium. The needle is inserted laterally to medially at a 45-degree angle, ensuring safe passage between the pleural sliding endpoint and the right internal thoracic vessels while reaching the pericardial effusion. CONCLUSION The presented technique provides real-time visualization of the needle and surrounding structures, which may potentially help to avoid complications and improve accuracy. The proposed technique may potentially enable access for emergency pericardiocentesis and for loculated pericardial effusion that has formed around the right atrium. Nevertheless, further studies with large patient populations are needed.
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Affiliation(s)
- Najem Abdullah Mohammed
- Emergency Department and Intensive Care Unit, Al Zamalh Hospital, Mawia Street, Taiz City, Yemen.
- Faculty of Medicine and Health Sciences, Taiz University, Habeel Street, Taiz, Yemen.
- POCUS Academy, Sana'a City, Yemen.
| | - Tanweer A Al-Zubairi
- Emergency Department and Intensive Care Unit, Al Zamalh Hospital, Mawia Street, Taiz City, Yemen
- Faculty of Medicine and Health Sciences, Taiz University, Habeel Street, Taiz, Yemen
| | - Moad H Al-Soumai
- Emergency Department and Intensive Care Unit, Al Zamalh Hospital, Mawia Street, Taiz City, Yemen
- Faculty of Medicine and Health Sciences, Taiz University, Habeel Street, Taiz, Yemen
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Osman A, Ahmad AH, Shamsudin NS, Baherin MF, Fong CP. A novel in-plane technique ultrasound-guided pericardiocentesis via subcostal approach. Ultrasound J 2022; 14:20. [PMID: 35596893 PMCID: PMC9124248 DOI: 10.1186/s13089-022-00271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background Cardiac tamponade occurs when fluid or blood, fills the pericardial space, and causes hemodynamic compromise due to compression of the heart. It is a potentially life-threatening condition, that requires rapid recognition and immediate treatment. Formerly, blind or surgical techniques were used, and it is associated with complications. Medical technology development has enabled us to perform the procedure safely, with the assistance of ultrasound devices. This article will highlight the novel use of an in-plane subcostal technique, as a safe option for pericardiocentesis in cardiac tamponade. Case presentation A 50-year-old man presented to the emergency department (ED) with shortness of breath and shock. He was intubated for respiratory distress. His bedside echocardiography showed cardiac tamponade. Ultrasound-guided pericardiocentesis was carried out using an in-plane technique, at the subcostal region, with a high-frequency linear ultrasound transducer. This particular method provided full visualization of needle trajectory throughout the procedure. It was successfully completed with no complications and patient’s hemodynamic status improved post-procedure. He was successfully discharged on day 13. Conclusions The in-plane subcostal pericardiocentesis is a safe, and simple approach that can be performed in the ED for patients with cardiac tamponade. We recommend this new in-plane method, with high-frequency linear transducer at the subcostal area as an alternative when cardiac window for other approaches cannot be visualized. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-022-00271-9.
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Affiliation(s)
- Adi Osman
- Consultant Emergency Physician & ED Critical Care, Resuscitation & Emergency Critical Care Unit (RECCU), Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia.
| | - Azma Haryaty Ahmad
- Consultant Emergency Physician & ED Critical Care, Resuscitation & Emergency Critical Care Unit (RECCU), Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia.
| | - Nurul Shaliza Shamsudin
- Emergency Physician, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Muhammad Faiz Baherin
- Emergency Physician, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Chan Pei Fong
- Consultant Emergency Physician & ED Critical Care, Resuscitation & Emergency Critical Care Unit (RECCU), Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
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Whiley PJ, Rodrigues N, Balasooriya J. A case of liver injury and pneumo-haemoperitoneum during pericardiocentesis. J Surg Case Rep 2022; 2022:rjac009. [PMID: 35145624 PMCID: PMC8826220 DOI: 10.1093/jscr/rjac009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
Pericardiocentesis is a generally safe procedure that provides effective resolution of cardiac tamponade. Emergency pericardiocentesis may be a life-saving intervention. Encountering an intra-abdominal organ in the path of the needle is predicted to be a potential complication in emergency subxiphoid approaches. Despite predictions of intraabdominal injuries, only few instances are recorded. In this case study, a patient recovering from percutaneous cardiac intervention required an emergency pericardiocentesis that was complicated by a liver injury, diaphragmatic penetration and pneumo-haemoperitoneum requiring surgical intervention to remove the drain. The case discusses options for performing the procedure, patient factors that can complicate the procedure and radiological and surgical diagnosis and treatment of this rare event.
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Affiliation(s)
- Phillip J Whiley
- The Australian National University Medical School, The Canberra Hospital, Canberra, ACT, Australia.,General Surgery Division, The Canberra Hospital, Canberra, ACT, Australia
| | - Nicole Rodrigues
- General Surgery Division, The Canberra Hospital, Canberra, ACT, Australia
| | - Janaka Balasooriya
- General Surgery Division, The Canberra Hospital, Canberra, ACT, Australia
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Baqi A, Ahmed I. Pericardiocentesis Indications and Complications: A Retrospective Observational Study in a Tertiary Care Hospital in Karachi, Pakistan. Cureus 2020; 12:e10102. [PMID: 33005522 PMCID: PMC7522186 DOI: 10.7759/cureus.10102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Pericardiocentesis is crucial for the diagnosis and management of diseases responsible for significant pericardial effusions. Pericardiocentesis was performed the first time by Riolanus for cardiac tamponade. He described the process of trephination of the sternum to remove the abnormally accumulated fluid from the pericardial space. However, with the advancement of expertise in echocardiography assisted procedures, echocardiography-guided diagnostic and therapeutic pericardiocentesis is now considered standard clinical practice in the treatment of pericardial effusions. OBJECTIVES We aim to study different causes of pericardial effusion and indications of pericardiocentesis as well as complications associated with it in our population. METHODS This is a retrospective observational study done at Aga Khan University Hospital, Karachi. We reviewed hospital record files of 66 patients admitted to Aga Khan University Hospital from January 2010 to December 2019 who underwent pericardiocentesis. RESULTS Out of 66 patients, 43 (65.2%) were male. The mean age of the study population was 48.59±18.9 years and 41 (62.1%) of them had underlying active malignancy with hematological malignancies being most common followed by lung carcinoma. In the majority of patients (71.2%), pericardiocentesis was performed at the bedside, and the rest of them (28.8%) underwent pericardiocentesis in the cardiac catheterization laboratory. Of all the patients, 46 (69.7%) underwent pericardiocentesis under echocardiography guidance and 18 (27.3%) required fluoroscopy. Successful pericardiocentesis was performed in 65 (98.5%) of the patients, two (3%) patients developed access site infection and only one (1.5%) patient became hemodynamically unstable while undergoing pericardiocentesis Conclusion: Malignancy, predominantly lymphoma, is the most common cause of pericardial effusion requiring pericardiocentesis. Dyspnea is the most common symptom of presentation with cardiac tamponade. Echocardiography is the commonly used imaging modality for pericardiocentesis. Bedside setting is the most common setting used for pericardiocentesis. Imaging guided pericardiocentesis has a very high success and low complication rate.
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Affiliation(s)
- Abdul Baqi
- Cardiology, Aga Khan University Hospital, Karachi, PAK
| | - Intisar Ahmed
- Cardiology, Aga Khan University Hospital, Karachi, PAK
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Abstract
Supplemental Digital Content is available in the text. Objective The aim of this study was to evaluate a novel pericardiocentesis technique using an in-plane parasternal medial-to-lateral approach with the use of a high-frequency probe in patients with cardiac tamponade. Background Echocardiography is pivotal in the diagnosis of pericardial effusion and tamponade physiology. Ultrasound guidance for pericardiocentesis is currently considered the standard of care. Several approaches have been described recently, which differ mainly on the site of puncture (subxiphoid, apical, or parasternal). Although they share the use of low-frequency probes, there is absence of complete control of needle trajectory and real-time needle visualization. An in-plane and real-time technique has only been described anecdotally. Methods and results A retrospective analysis of 11 patients (63% men, mean age: 37.7±21.2 years) presenting with cardiac tamponade admitted to the tertiary-care emergency department and treated with parasternal medial-to-lateral in-plane pericardiocentesis was carried out. The underlying causes of cardiac tamponade were different among the population. All the pericardiocentesis were successfully performed in the emergency department, without complications, relieving the hemodynamic instability. The mean time taken to perform the eight-step procedure was 309±76.4 s, with no procedure-related complications. Conclusion The parasternal medial-to-lateral in-plane pericardiocentesis is a new technique theoretically free of complications and it enables real-time monitoring of needle trajectory. For the first time, a pericardiocentesis approach with a medial-to-lateral needle trajectory and real-time, in-plane, needle visualization was performed in a tamponade patient population.
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Sullivan A, Khait L, Favot M. A Novel Low-Cost Ultrasound-Guided Pericardiocentesis Simulation Model: Demonstration of Feasibility. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:493-500. [PMID: 28777457 DOI: 10.1002/jum.14337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 04/28/2017] [Indexed: 06/07/2023]
Abstract
Pericardiocentesis is a rare life-saving procedure for patients with cardiac tamponade. Due to the infrequency of this procedure, simulation models are often used for training. Commercial models are generally expensive. Proposed homemade models offer a lower-cost alternative but can be labor and time intensive. The purpose of this study was to determine the feasibility of a limited use, low-cost ultrasound-guided pericardiocentesis model as a training tool for emergency physicians. Our model proved to be a practical, easily implemented, and acceptable model for training emergency physicians, including residents and students, in ultrasound-guided pericardiocentesis.
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Affiliation(s)
- Ashley Sullivan
- Department of Emergency Medicine, St John Hospital and Medical Center, Detroit, Michigan, USA
- Department of Emergency Medicine, Wayne State School of Medicine, Detroit, Michigan, USA
| | - Lyudmila Khait
- Department of Emergency Medicine, Detroit Medical Center, Detroit, Michigan, USA
- Department of Emergency Medicine, Wayne State School of Medicine, Detroit, Michigan, USA
| | - Mark Favot
- Department of Emergency Medicine, Detroit Medical Center, Detroit, Michigan, USA
- Department of Emergency Medicine, Wayne State School of Medicine, Detroit, Michigan, USA
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Liebenberg J, van der Bijl P. A "Vanishing", Tuberculous, Pericardial Effusion. Korean Circ J 2016; 46:879-881. [PMID: 27826351 PMCID: PMC5099348 DOI: 10.4070/kcj.2016.46.6.879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/23/2015] [Accepted: 12/17/2015] [Indexed: 11/29/2022] Open
Abstract
We present an iatrogenic, pleuro-pericardial connection resulting from pericardiocentesis of a large, tuberculous, pericardial effusion. Recognition of this situation is paramount when one is unable to aspirate pericardial fluid after a successful, initial puncture. Such knowledge will help prevent myocardial or coronary artery injury with further attempts at aspiration.
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Affiliation(s)
- Jacques Liebenberg
- Department of Internal Medicine, Kimberley Provincial Hospital, Du Toitspan Road, Kimberley Hospital, Kimberley, South Africa
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Computed tomography-guided pericardiocentesis – A single-center experience. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Neves D, Silva G, Morais G, Ferreira N, Carvalho M, Gama Ribeiro V, Bettencourt N. Computed tomography-guided pericardiocentesis – A single-center experience. Rev Port Cardiol 2016; 35:285-90. [DOI: 10.1016/j.repc.2015.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/22/2015] [Indexed: 11/27/2022] Open
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Maggiolini S, Gentile G, Farina A, De Carlini CC, Lenatti L, Meles E, Achilli F, Tempesta A, Brucato A, Imazio M. Safety, Efficacy, and Complications of Pericardiocentesis by Real-Time Echo-Monitored Procedure. Am J Cardiol 2016; 117:1369-74. [PMID: 26956635 DOI: 10.1016/j.amjcard.2016.01.043] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/18/2016] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
Abstract
Pericardiocentesis is useful in the diagnosis and treatment of pericardial effusive disease. To date, a number of methods have been developed to reduce complications and increase the success rate of the procedure. The aim of the present study was to evaluate the efficacy and the safety of echocardiography-guided pericardiocentesis under continuous echocardiographic monitoring in the management of pericardial effusion. We prospectively performed 161 pericardiocentesis procedures in 141 patients admitted from 1993 to 2015 in 3 centers. This procedure was performed for tamponade or large pericardial effusion in 157 cases and for diagnosis in 4 cases. A percutaneous puncture was performed where the largest amount of fluid was detected. To perform a real-time echo-guided procedure, a multi-angle bracket was mounted on the echocardiographic probe to support the needle and enable its continuous visualization during the puncture. The procedure was successful in 160 of 161 cases (99%). Two major complications occurred (1.2%): 1 mediastinal hematoma that required surgical drainage in a patient on anticoagulant therapy and 1 pleuropericardial shunt requiring thoracentesis. Seven minor complications occurred (4.3%): 1 pleuropericardial shunt, 1 case of transient AV type III block, 3 vasovagal reactions (1 with syncope), and 2 cases of acute pulmonary edema managed with medical therapy. No punctures of any cardiac chamber occurred, and emergency surgical drainage was not required in any case. In conclusion, echocardiography-guided pericardiocentesis under continuous visualization is effective, safe, and easy to perform, even in hospitals with low volumes of procedures with or without cardiac surgery.
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Kumar R, Sinha A, Lin MJ, Uchino R, Butryn T, O'Mara MS, Nanda S, Shirani J, Stawicki SP. Complications of pericardiocentesis: A clinical synopsis. Int J Crit Illn Inj Sci 2015; 5:206-12. [PMID: 26557491 PMCID: PMC4613420 DOI: 10.4103/2229-5151.165007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Pericardiocentesis (PC) is both a diagnostic and a potentially life-saving therapeutic procedure. Currently echocardiography-guided pericardiocentesis is considered the standard clinical practice in the treatment of large pericardial effusions and cardiac tamponade. Although considered relatively safe, this invasive procedure may be associated with certain risks and potentially serious complications. This review provides a summary of pericardiocentesis and a focused overview of the potential complications of this procedure.
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Affiliation(s)
- Rajan Kumar
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Archana Sinha
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Maggie J Lin
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Reina Uchino
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Tracy Butryn
- Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - M Shay O'Mara
- Department of Surgery, OhioHealth Grant Medical Center, Columbus, Ohio, United States
| | - Sudip Nanda
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Jamshid Shirani
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Stanislaw P Stawicki
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States ; Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
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Maggiolini S, De Carlini CC, Ferri LA, Colombo GI, Gentile G, Meles E, Riva B, Casella TC, Imazio M, Brucato A. The role of early contrast-enhanced chest computed tomography in the aetiological diagnosis of patients presenting with cardiac tamponade or large pericardial effusion. Eur Heart J Cardiovasc Imaging 2015; 17:421-8. [PMID: 26377905 DOI: 10.1093/ehjci/jev225] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/20/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS The role of chest computed tomography (CT) is not well defined for either diagnosis or management of pericardial disease. The aim of this study was to evaluate the added value of early chest CT in the diagnostic workup for patients presenting with cardiac tamponade or large pericardial effusion of unknown aetiology as the first manifestation of disease. METHODS AND RESULTS We performed CT scan on 55 patients with pericardial effusion as defined above, undergoing echo-guided pericardiocentesis. We compared the success rate in making diagnosis and/or staging the underlying disorder of three sequential workups, including, respectively, (i) clinical presentation, inflammatory markers, chest X-ray imaging, (ii) all of the above and pericardial fluid analysis, and (iii) all of the above and chest CT. We were able to make diagnosis in 53 patients (96%): the major cause of effusion was malignancy (38%). Clinical and biochemical data were not able to differentiate non-tumour from tumour patients. CT revealed pathological findings in all patients with malignancy: tumour mass in 15/21 (71%) and pathological lymphadenopathy in the remaining 6 cases. The workup including CT provided a significantly higher diagnostic yield than the other two workups (P < 0.0001), both in the overall population and in the two subgroups of neoplastic (Npl) and non-Npl patients. CONCLUSION In all patients with cardiac tamponade or large pericardial effusion, CT was useful either in identifying the underlying disease or in excluding other potential causes of pericardial effusion. We conclude that chest CT is a very useful non-invasive diagnostic tool to identify and stage pericardial diseases.
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Affiliation(s)
- Stefano Maggiolini
- Department of Cardiology, San L. Mandic Hospital, Largo Mandic 1, Merate, Lecco 23807, Italy
| | - Caterina C De Carlini
- Department of Cardiology, San L. Mandic Hospital, Largo Mandic 1, Merate, Lecco 23807, Italy
| | - Luca A Ferri
- Department of Cardiology, A. Manzoni Hospital, Lecco, Italy
| | - Gualtiero I Colombo
- Laboratory of Immunology and Functional Genomics, Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Gaetano Gentile
- Department of Cardiology, San L. Mandic Hospital, Largo Mandic 1, Merate, Lecco 23807, Italy
| | - Ester Meles
- Department of Cardiology, San L. Mandic Hospital, Largo Mandic 1, Merate, Lecco 23807, Italy
| | - Beatrice Riva
- Department of Cardiology, A. Manzoni Hospital, Lecco, Italy
| | - Teresa C Casella
- Department of Radiology, San L. Mandic Hospital, Merate, Lecco, Italy
| | - Massimo Imazio
- Cardiology Department, Maria Vittoria Hospital and University of Torino, Torino, Italy
| | - Antonio Brucato
- Division of Internal Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Andrus P, Dean A. Focused Cardiac Ultrasound. Glob Heart 2013; 8:299-303. [DOI: 10.1016/j.gheart.2013.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 12/05/2013] [Indexed: 11/27/2022] Open
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Degirmencioglu A, Karakus G, Güvenc TS, Pinhan O, Sipahi I, Akyol A. Echocardiography-guided or "sided" pericardiocentesis. Echocardiography 2013; 30:997-1000. [PMID: 23593965 DOI: 10.1111/echo.12214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Echocardiography-guided pericardiocentesis is the first choice method for relieving cardiac tamponade, but the exact role of the echocardiography at the moment of the puncture is still controversial. In this report, detailed echocardiographic evaluation was performed in 21 consecutive patients with cardiac tamponade just before the pericardiocentesis. Appropriate needle position was determined according to the probe position using imaginary x, y, and z axes. Pericardiocentesis was performed successfully using this technique without simultaneous echocardiography and no complications were observed. We concluded that bedside echocardiography with detailed evaluation of the puncture site and angle is enough for pericardiocentesis instead of real time guiding.
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Blind subxiphoid pericardiotomy to relieve critical acute hemopericardium: a final report. Eur J Trauma Emerg Surg 2012; 38:563-8. [PMID: 26816259 DOI: 10.1007/s00068-012-0200-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 05/31/2012] [Indexed: 02/07/2023]
Abstract
PURPOSE Percutaneous catheter drainage (PCD) has been considered a standard method of relieving acute cardiac tamponade. Although conventional subxiphoid pericardiotomy is useful even for clotted hemopericardium, it has been believed to be unsuitable for emergency treatment because it is a time-consuming procedure. We report our modified pericardiotomy technique that can be used for emergency management. METHODS We designed a prospective observational study to evaluate blind subxiphoid pericardiotomy (BSP) for critical cardiac tamponade due to hemopericardium. Emergency patients (n = 148) with acute hemopericardium secondary to trauma (n = 12), acute aortic disease (n = 122), or cardiac rupture following acute myocardial infarction (n = 14) were the subjects. Early results were compared between the BSP group (n = 53) and the PCD group (n = 95). RESULTS BSP was effective at relieving cardiac tamponade in all 53 cases, but PCD was ineffective in 12 cases (12.6 %, p = 0.008). Procedure-related complication rates of BSP and PCD were 0 and 16.8 %, respectively (p = 0.002). Survival rates for the BSP and PCD groups were 18.9 and 6.3 %, respectively (p = 0.018). Since 2005, when we discarded the restriction that only board-certified surgeons should perform BSP, acute care physicians (including trainees) have performed BSP for 22 patients without procedure-related complications. CONCLUSIONS BSP was safe and effective for cardiac tamponade due to acute hemopericardium. Critical complications during PCD for hemopericardium could not be avoided in some cases because of clots in the pericardium.
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Loukas M, Walters A, Boon J, Welch T, Meiring J, Abrahams P. Pericardiocentesis: A clinical anatomy review. Clin Anat 2012; 25:872-81. [DOI: 10.1002/ca.22032] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 10/20/2011] [Accepted: 12/19/2011] [Indexed: 11/08/2022]
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Abstract
Combat medical care provides unique challenges and opportunities for military medical teams. The austerity of the environment severely limits access to many diagnostic and therapeutic tools. Because of their compact size, handheld ultrasound (US) machines are increasingly being used in these constrained environments. A growing body of literature documents the diagnostic utility of handheld US for trauma encountered in the battlefield. Furthermore, US guidance may assist in the performance of some procedures performed in battlefield medical care. This review will provide an overview of the history, current status, limitations and potential future of US utility for the battlefield.
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Abstract
Emergency echocardiography refers to the use of cardiac ultrasound to address critical and time-sensitive clinical questions during the initial evaluation and treatment of the critically ill patient presenting to the emergency department. The information obtained can be pivotal to a physician's clinical decision making and can guide further diagnostic or therapeutic interventions. This article provides an evidence-based discussion of the common uses of emergency transthoracic echocardiography, as well as its benefits and limitations in the current practice of emergency medicine.
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Warsame TA, Yang HS, Mookadam F, Sorajja D, Den Y, Moustafa SE, Alharthi MS, Chandrasekaran K. Fatal migratory pulmonary thromboembolism following successful pericardiocentesis. Echocardiography 2011; 27:E125-7. [PMID: 20553319 DOI: 10.1111/j.1540-8175.2010.01215.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Echocardiography-guided pericardiocentesis is relatively safe with minimal risk in experienced hands. However, complications can occur because of the procedure. This report describes a unique case of an 84-year-old man with unanticipated fatal pulmonary thromboembolism following a successful pericardiocentesis.
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Affiliation(s)
- Tahlil A Warsame
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
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Deakin CD, Morrison LJ, Morley PT, Callaway CW, Kerber RE, Kronick SL, Lavonas EJ, Link MS, Neumar RW, Otto CW, Parr M, Shuster M, Sunde K, Peberdy MA, Tang W, Hoek TLV, Böttiger BW, Drajer S, Lim SH, Nolan JP. Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2011; 81 Suppl 1:e93-e174. [PMID: 20956032 DOI: 10.1016/j.resuscitation.2010.08.027] [Citation(s) in RCA: 167] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Vanden Hoek TL, Morrison LJ, Shuster M, Donnino M, Sinz E, Lavonas EJ, Jeejeebhoy FM, Gabrielli A. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122:S829-61. [PMID: 20956228 DOI: 10.1161/circulationaha.110.971069] [Citation(s) in RCA: 388] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Morrison LJ, Deakin CD, Morley PT, Callaway CW, Kerber RE, Kronick SL, Lavonas EJ, Link MS, Neumar RW, Otto CW, Parr M, Shuster M, Sunde K, Peberdy MA, Tang W, Hoek TLV, Böttiger BW, Drajer S, Lim SH, Nolan JP, Adrie C, Alhelail M, Battu P, Behringer W, Berkow L, Bernstein RA, Bhayani SS, Bigham B, Boyd J, Brenner B, Bruder E, Brugger H, Cash IL, Castrén M, Cocchi M, Comadira G, Crewdson K, Czekajlo MS, Davies SR, Dhindsa H, Diercks D, Dine CJ, Dioszeghy C, Donnino M, Dunning J, El Sanadi N, Farley H, Fenici P, Feeser VR, Foster JA, Friberg H, Fries M, Garcia-Vega FJ, Geocadin RG, Georgiou M, Ghuman J, Givens M, Graham C, Greer DM, Halperin HR, Hanson A, Holzer M, Hunt EA, Ishikawa M, Ioannides M, Jeejeebhoy FM, Jennings PA, Kano H, Kern KB, Kette F, Kudenchuk PJ, Kupas D, La Torre G, Larabee TM, Leary M, Litell J, Little CM, Lobel D, Mader TJ, McCarthy JJ, McCrory MC, Menegazzi JJ, Meurer WJ, Middleton PM, Mottram AR, Navarese EP, Nguyen T, Ong M, Padkin A, Ferreira de Paiva E, Passman RS, Pellis T, Picard JJ, Prout R, Pytte M, Reid RD, Rittenberger J, Ross W, Rubertsson S, Rundgren M, Russo SG, Sakamoto T, Sandroni C, Sanna T, Sato T, Sattur S, Scapigliati A, Schilling R, Seppelt I, Severyn FA, Shepherd G, Shih RD, Skrifvars M, Soar J, Tada K, Tararan S, Torbey M, Weinstock J, Wenzel V, Wiese CH, Wu D, Zelop CM, Zideman D, Zimmerman JL. Part 8: Advanced Life Support. Circulation 2010; 122:S345-421. [DOI: 10.1161/circulationaha.110.971051] [Citation(s) in RCA: 250] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Winter M, Lim I, Joseph M. The Disappearing Pericardial Effusion: A Pericardial-Pleural Fistula. J Am Soc Echocardiogr 2009; 22:973.e5-7. [DOI: 10.1016/j.echo.2009.03.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Indexed: 11/30/2022]
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Blackstock U, Stone MB. Emergency Ultrasonography and Error Reduction. Ann Emerg Med 2009; 54:53-5. [DOI: 10.1016/j.annemergmed.2009.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Revised: 12/12/2008] [Accepted: 02/16/2009] [Indexed: 12/15/2022]
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Evaluation of Congenital Heart Diseases with Real-time Three-dimensional Echocardiography. J Med Ultrasound 2008. [DOI: 10.1016/s0929-6441(08)60011-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Reports on the aetiologic distribution of acute pericarditis vary significantly from study to study. We attempted to summarise reports on incidence of different aetiologies of pericarditis and explain the variable range of reported frequencies of different aetiologies. The literature between 1978 and 2005 was reviewed for comparative incidence of acute pericarditis. Reports of more than 50 subjects were included. The most common cause of pericarditis was 'idiopathic' pericarditis (mean: 26.1%), followed by neoplastic diseases (mean: 25.6%) and iatrogenic pericarditis (mean: 16.3%). Each mean had a wide range of 95% confidence interval. In summary, the clinician is confronted by a huge dispersion of reported frequencies of pericarditis aetiologies as a consequence of multiple factors. Recognising specific rare causes of pericarditis, often essential for early diagnosis and successful treatment, means coping with that aetiologic dispersion and its implied probabilities.
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Affiliation(s)
- M Lorbar
- Division of Cardiology, Department of Medicine, St. Vincent Hospital, Worcester, MA, USA
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Kurimoto Y, Hase M, Nara S, Yama N, Kawaharada N, Morishita K, Higami T, Asai Y. Blind subxiphoid pericardiotomy for cardiac tamponade because of acute hemopericardium. ACTA ACUST UNITED AC 2006; 61:582-5. [PMID: 16966991 DOI: 10.1097/01.ta.0000236060.37952.ce] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Percutaneous catheter drainage (PCD) is not always effective in a case of hemopericardium. Acute occlusion of catheter and cardiac perforation can happen more often. To perform subxiphoid pericardiotomy within a minute for emergency cases, we have done this procedure in a blind method after finger dissection by subxiphoid approach. We report the usefulness of blind subxiphoid pericardiotomy (BSP) based on the results of a prospective control study. METHODS We designed a study to determine a favorable management for cardiac tamponade resulting from hemopericardium. In an emergency case of cardiac tamponade because of hemopericardium, board certified surgeons should perform BSP and other emergency physicians should perform PCD, with or without local anesthesia. PCD (n = 67) and BSP (n = 16) were performed for patients with cardio-pulmonary arrest (CPA) or near CPA because of cardiac tamponade secondary to trauma (n = 7), acute aortic dissection (n = 65), and cardiac rupture following acute myocardial infarction (n = 11) in our emergency medical center from January 2000 to December 2004. RESULTS BSP was effective in all cases but PCD was ineffective in five cases because of clotting in pericardium (p = 0.260). No complication was observed in the BSP group but five critical complications and three infeasible drainage complications were observed in the PCD group (p = 0.146). Ten patients (BSP, 4; PCD, 6; p = 0.077) survived after emergency surgery (n = 8) or conservative treatment (n = 2). CONCLUSION BSP was safe and could be performed quickly in an emergency situation. Percutaneous catheter drainage for hemopericardium could not avoid critical complications because of clotting in pericardium.
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Affiliation(s)
- Yoshihiko Kurimoto
- Department of Traumatology and Critical Care Medicine, Sapporo Medical University, Sapporo, Japan.
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Klein SV, Afridi H, Agarwal D, Coughlin BF, Schielke LH. CT directed diagnostic and therapeutic pericardiocentesis: 8-year experience at a single institution. Emerg Radiol 2005; 11:353-63. [PMID: 16344977 DOI: 10.1007/s10140-004-0389-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Accepted: 11/24/2004] [Indexed: 11/28/2022]
Abstract
UNLABELLED A retrospective review of the 8-year experience at a single institution performing more than 300 CT directed pericardiocenteses was performed. The technique, results, and complications were determined. Comparative data from the literature relating to cardiology and thoracic surgery are reviewed. A CPT code data base search was performed to identify all imaging directed pericardiocenteses at a 550 bed regional medical center between 1993 and 2001. Medical records, imaging studies, and reports as well as pertinent laboratory, chemistry and hematology values were reviewed. Demographics, results, fluid analyses, techniques, systems used and complications were recorded. RESULTS Three hundred and nineteen pericardiocenteses using CT localization were attempted on 261 patients. One hundred and forty-two men were included and mean age was 61 years (range 6 months to 89 years). Mean volume aspirated was 418 cc (range 0-1,875 cc). The major complication rate was 0.3%; the minor complication rate was 6.9%. Technical success was achieved in 98.4% procedures. Emergent pericardiocentesis was performed on anticoagulated patients without significant bleeding. Seventy-nine percent of patients with echocardiographic evidence of tamponade had symptomatic improvement. Patients with marked shortness of breath without other evidence of tamponade benefited symptomatically in 78%. Pericardiocenteses with CT localization is relatively safe and many patients achieve symptomatic relief.
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Affiliation(s)
- S V Klein
- Department of Radiology, Baystate Medical Center, Springfield, MA, 01199, USA.
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Lindenberger M, Kjellberg M, Karlsson E, Wranne B. Pericardiocentesis guided by 2-D echocardiography: the method of choice for treatment of pericardial effusion. J Intern Med 2003; 253:411-7. [PMID: 12653869 DOI: 10.1046/j.1365-2796.2003.01103.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Percutaneous pericardiocentesis guided by 2-D echocardiography has been used at Linköping Heart Centre since 1983. AIM To evaluate our experience of this method including a follow-up and also to determine the aetiology of pericardial effusion. METHODS A retrospective study including 120 of 252 consecutive patients punctured. RESULTS The two most common aetiologies were cardiac surgery (77% valve surgery), followed by malignant disease. The postsurgical effusions became clinically important a median of 12 days after surgery (range 0-56 days). The median survival in the group with malignant disease was 89 days (30-day survival 87%, 1-year survival 10%). Indwelling catheter was used in 93% of the patients. There was no mortality but one patient needed a second pericardiocentesis after an accidental puncture of the right ventricle. Nine patients had rhythm aberrations. Recurring effusion that needed puncture was seen in 8%. CONCLUSION Pericardiocentesis guided by 2-D echocardiography is a safe and efficient method to treat pericardial effusion and also valuable as palliative treatment for patients with malignant aetiology of the effusion.
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Affiliation(s)
- M Lindenberger
- Department of Medicine and Care, Faculty of Health Sciences, Linköping University, Sweden
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