Clinical study
Pericardiocentesis

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Abstract

Pericardiocentesis in 123 patients during 1970–1976 was reviewed with regard to the benefits and risks of the procedure. Fluid was obtained in about one half of the patients in whom echocardiography showed only a small pericardial effusion or an effusion located only posteriorly. Fluid was obtained in over 90 per cent of the patients in whom the effusion was large and/or located both anteriorly and posteriorly. Specific etiologic diagnoses of neoplasm, bacterial infection, chylous effusion or hemopericardium were made in 24 per cent of the fluids examined, including 27 per cent of those from patients with elevated venous pressure levels and only 14 per cent of those from patients with normal venous pressure. Carcinomatous pericardial invasion was correctly identified by cytologic examination in each instance, but falsely negative cytology was found in some patients with lymphoma or mesothelioma. Increased venous pressure was due to simple tamponade (62 per cent), visceral constriction (17 per cent), congestive heart failure (16 per cent) or superior vena caval obstruction (5 per cent). Cardiac tamponade was successfully managed by pericardiocentesis alone in 61 per cent. Complications included two immediate deaths, both in patients already in the terminal phase, two deaths possibly related to delay of surgical therapy and one death following a catheter-related purulent pericarditis in a patient with terminal cancer. Two of five instances of nonfatal hemopericardium with tamponade occurred in patients with platelet counts less than 50,000/mm3. Although it has inherent risks, which may exceed those of coronary arteriography, pericardiocentesis is a worthwhile initial approach to the diagnosis and management of pericardial effusion, particularly when the venous pressure level is elevated. The procedure should be performed by experienced persons, in a setting in which maximum diagnostic and physiologic information can be obtained, and where alternative surgical therapy is promptly available.

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Cited by (165)

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    Urgent pericardiocentesis is necessary when a patient is in cardiac tamponade to reverse the cascade of hemodynamic collapse. Previously, pericardiocentesis was frequently done without ultrasound guidance and was considered to have high morbidity and mortality [2]. Although increased use of echocardiographic guidance has yielded higher success rates and lower morbidity, [3–4] patients with significant pulmonary arterial hypertension (PAH) are still considered to be at higher risk during pericardiocentesis.

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    Pericardiocentesis is an emergent intervention for pericardial tamponade, a life-threatening condition (3). Compared to the traditional “blind” approach, ultrasound-guided pericardiocentesis (USGP) has emerged as the preferred technique due to higher success rates and fewer complications (3–9). Pericardiocentesis is a low-frequency, high-risk procedure that some EM trainees may have limited exposure to.

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    General anesthesia, intubation, and positive pressure ventilation should be avoided before pericardial drainage is begun. A comparative analysis of feasibility and safety of major pericardiocentesis series is presented in Table 1.8,10,12,15,17–24 In the Mayo Clinic series of 1127 echocardiography-guided pericardiocenteses, 97% of the procedures were successful and associated with only 1.2% major and 3.5% minor complications.10

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This work was supported in part by Grants CA-08122 and CA-05838 from the National Cancer Institute, NIH, Bethesda, Maryland.

1

From the Divisions of Oncology and Cardiology, Stanford University School of Medicine, Stanford, California 94305.

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