A Spontaneously Resolving Pericardial Effusion During CPR

Abstract

A 62-year-old woman was initially transferred from an outside hospital for workup and management of a pericardial effusion. The patient had daily transthoracic echocardiograms which showed an effusion without tamponade physiology (Video 1). Subsequently, the patient developed respiratory distress associated with syncope and went into pulseless electrical activity (PEA) arrest. A code was called during which a point of care ultrasound (POCUS) was performed (Video 2) and showed a large pericardial effusion with evidence of tamponade and pseudo PEA-a state of severe shock in which the cardiac output is insufficient for perfusion. While setting up for emergent pericardial drainage, after 13 min of CPR, the patient achieved return of spontaneous circulation (ROSC) (Narration Video). Question: Based on the cardiac echocardiogram before, during, and after ROSC, what is the likely cause for the patient's cardiac arrest?