DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20214080

Techniques, indications and complications of pericardiocentesis

Mohammed Shafik Elkahwagy, Ahmad Faraj Alenezi, Hibah Farhan Alenezi, Bader Naji Al-Hussain, Mohammad Ahmad Allwaim, Almukhtar Mohammed Almomatten, Mohammed Ali Alkhuwaysah, Mohammed Abdullah Alwabari, Thumamah Mahmoud Alarabi, Mohammed Hamed Albarakati, Naif Abdullah Albadrani, Nasser Dakhel Alrehaili

Abstract


The main aim of pericardiocentesis is to remove excess fluid in the pericardial space and enhance the functions of the heart to intervene against the development of many complications. Accordingly, the procedure is usually performed to manage cardiac tamponade to correct secondary hypotension that attributes to the low stroke volume as a result of the external pressure of the pericardial fluid on the chambers of the heart. In the present literature review, we have discussed the techniques, indications, and complications of pericardiocentesis. Furthermore, the main techniques and approaches include computed tomography-guided pericardiocentesis, echo-guided, and fluoroscopy-guided techniques. These modalities can be successfully used for hemodynamically unstable patients to adequately remove excess fluid to normalize ventricular filling and maintain adequate cardiac output to the peripheral tissues. Considerations for using the modality have been made for small effusions and many authors suggest that it should not be routinely used in these situations. Many major and minor complications can occur secondary to conducting pericardiocentesis. The major complications might include lacerations of the intercostal vessels of the coronary arteries, injury to the cardiac chambers, death, puncture of the peritoneal cavity or abdominal viscera, pneumopericardium, pneumothorax which might require chest intubation, pericardial decompression syndrome, and ventricular arrhythmias. Therefore, carefully approaching these patients and deciding the best management plan, in addition to providing proper interventional approaches for the potential development of these complications is essential to enhance the intended outcomes and enhance the quality of care.


Keywords


Pericardiocentesis, Complications, Indications, Cardiac tamponade

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References


Cruz I, Stuart B, Caldeira D. Controlled pericardiocentesis in patients with cardiac tamponade complicating aortic dissection: experience of a centre without cardiothoracic surgery. Euro heart J Acute cardiovascular care. 2015;4(2):124-8.

Akyuz S, Zengin A, Arugaslan E. Echo-guided pericardiocentesis in patients with clinically significant pericardial effusion. Outcomes over a 10-year period. Herz. 2015;40(2):153-9.

Adler Y, Charron P, Imazio M. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015;36(42):2921-64.

Krikorian JG, Hancock EW. Pericardiocentesis. Am j med. 1978;65(5):808-14.

Chetrit M, Lipes J, Mardigyan V. A Practical Approach to Pericardiocentesis With Periprocedural Use of Ultrasound Training Initiative. Canadian j cardiol. 2018;34(9):1229-32.

Schusler R, Meyerson SL. Pericardial Disease Associated with Malignancy. Curr cardiol rep. 2018;20(10):92.

Vilela EM, Ruivo C, Guerreiro CE. Computed tomography-guided pericardiocentesis: a systematic review concerning contemporary evidence and future perspectives. Therap advances cardiovascular dis. 2018;12(11):299-307.

Jung HO. Pericardial effusion and pericardiocentesis: role of echocardiography. Korean circulation j. 2012;42(11):725-34.

Maggiolini S, Gentile G, Farina A. Safety, Efficacy, and Complications of Pericardiocentesis by Real-Time Echo-Monitored Procedure. Am J Cardiol. 2016;117(8):1369-74.

Tsang TSM, Freeman WK, Sinak LJ, Seward JB. Echocardiographically Guided Pericardiocentesis: Evolution and State-of-the-Art Technique. Mayo Clin proceedings. 1998;73(7):647-52.

Kumar R, Sinha A, Lin MJ. Complications of pericardiocentesis: A clinical synopsis. Int J Crit Illn Inj Sci. 2015;5(3):206-12.

Neves D, Silva G, Morais G. Computed tomography-guided pericardiocentesis-A single-center experience. Revista Portuguesa de Cardiologia. 2016;35(5):285-90.

Maggiolini S, De Carlini CC, Ferri LA. 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- Cardiovascular Imaging. 2015;17(4):421-8.

Tsang TSM, Seward JB. Pericardiocentesis Under Echocardiographic Guidance. Eur J Echocardiography. 2001;2(1):68-9.

Sinnaeve PR, Adriaenssens T. A contemporary look at pericardiocentesis. Trends cardiovascular med. 2019;29(7):375-83.

Ristić AD, Imazio M, Adler Y. Triage strategy for urgent management of cardiac tamponade: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2014;35(34):2279-84.

Pham TS, Reda A, Ngan Nguyen TT. Blood exchange transfusion in viral hepatitis in a small infant: a case report. Transfusion and apheresis sci. 2020;59(6):102907.

Cooper CA. Centesis studies in critical care. Critcare nursing clin North Am. 2010;22(1):95-108.

Thomas F, Clemmer TP, Orme JF, Jr. A survey of advanced trauma life support procedures being performed by physicians and nurses used on hospital aeromedical evacuation services. Aviation, space environmental med. 1985;56(12):1213-5.

Alpert EA, Amit U, Guranda L, Mahagna R, Grossman SA, Bentancur A. Emergency department point-of-care ultrasonography improves time to pericardiocentesis for clinically significant effusions. Clin exp emergency med. 2017;4(3):128-32.

Maggiolini S, Osculati G, Vitale G. Utility and safety of diagnostic pericardiocentesis. Eur Heart J. 2005;26(10):1046-7.

Son PT, Reda A, Viet DC. Exchange transfusion in the management of critical pertussis in young infants: a case series. Vox Sang. 2021.

Lekhakul A, Fenstad ER, Assawakawintip C. Incidence and Management of Hemopericardium: Impact of Changing Trends in Invasive Cardiology. Mayo Clin proceedings. 2018;93(8):1086-95.

Honasoge AP, Dubbs SB. Rapid Fire: Pericardial Effusion and Tamponade. Emergency med clin North Am. 2018;36(3):557-65.

Tsang TSM, Enriquez-Sarano M, Freeman WK. Consecutive 1127 Therapeutic Echocardiographically Guided Pericardiocenteses: Clinical Profile, Practice Patterns, and Outcomes Spanning 21 Years. Mayo Clin proceedings. 2002;77(5):429-36.

Akyuz S, Zengin A, Arugaslan E. Echo-guided pericardiocentesis in patients with clinically significant pericardial effusion. Herz. 2015;40(2):153-9.

Thieu H, Bach Dat B, Nam NH. Antibiotic resistance of Helicobacter pylori infection in a children's hospital in Vietnam: prevalence and associated factors. Minerva med. 2020;111(5):498-501.

Narula J, Choudhury A, Sharma A. Pericardiocentesis can be nasty. Accidents do occur while "Rail-roading" Sheaths and pigtails! Ann cardiac anaesthesia. 2018;21(3):290-92.

Lekhakul A, Assawakawintip C, Fenstad ER, et al. Safety and Outcome of Percutaneous Drainage of Pericardial Effusions in Patients with Cancer. Am j cardiol. 2018;122(6):1091-4.