A contemporary look at pericardiocentesis

Abstract

Percutaneous drainage is the default strategy for evacuating a pericardial effusion. A pericardiocentesis can be necessary or required in a wide variety of clinical settings ranging from urgent tamponade to relieve in iatrogenic hemorrhagic effusions in the electrophysiology or catheterization room, to planned diagnostic procedures in patients with suspected or known malignancy or infections. With the help of several procedural improvements over the past decades, echocardiography and fluoroscopy-guided percutaneous pericardiocentesis has become the standard intervention for evacuating pericardial effusions, as well as an essential tool in the diagnostic work-up of an unexplained pericardial effusion. When performed by skilled physicians assisted by appropriate imaging it is a very safe procedure, and provided that an indwelling catheter is placed, it is also very effective with an acceptably low risk of recurrences. In this review, the indications and standard techniques for pericardiocentesis are discussed, as well as their consequences for patients with iatrogenic and malignant effusions.

Temporal trends, outcomes, and predictors of mortality after pericardiocentesis in the United States

“…Pericardiocentesis, either echocardiographically or fluoroscopically guided, is an effective treatment modality performed either emergently or electively for a myriad of indications ranging from sizeable pericardial effusion resistant to medical management to diagnostic taps for unknown etiology . Pericardiocentesis may be associated with minor and major complications that include but are not limited to: pneumothorax, catheterization of the wrong site and/or organ, cardiac puncture, coronary artery laceration, massive hemorrhage, and intra‐procedural death .…”

“…Pericardiocentesis, either echocardiographically or fluoroscopically guided, is an effective treatment modality performed either emergently or electively for a myriad of indications ranging from sizeable pericardial effusion resistant to medical management to diagnostic taps for unknown etiology. 1,2 Pericardiocentesis may be associated with minor and major complications that include but are not limited to: Note: Table 1 showing the observed baseline differences between patients who underwent pericardiocentesis with cardiac procedures during hospitalization versus patients who underwent pericardiocentesis in hospitalizations without procedures. and an interventional procedure at the same hospitalization versus those who did not (Tables S1 presents the corresponding ICD-9 codes used in the current article, as well as a comparison between pericardiocentesis and surgical pericardial interventions).…”

What is the ideal approach for emergent pericardiocentesis using point-of-care ultrasound guidance?

“…Several other observational studies demonstrated that the parasternal approach was superior to the traditional subxiphoid approach. [18][19][20][21] In our study, the parasternal approach had the lowest predicted complication rate with a shorter mean skin-to-pericardial fluid distance compared to the subxiphoid approach. Our study suggests that the parasternal approach is superior to the subxiphoid approach even under ultrasound guidance.…”

Coronary artery perforation secondary to lifesaving pericardiocentesis for cardiac tamponade: a case report

“…Pericardiocentesis is an important procedure for treating cardiac tamponade, and echocardiography-guided pericardiocentesis has been recognized as a safe and feasible technique that has low complication rates. However, it can still be a high-risk procedure in inexperienced hands and/or an emergency setting [1]. Here we report a case of right coronary artery perforation secondary to pericardiocentesis for cardiac tamponade.…”