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Cardiac Arrest Caused by Cardiac Tamponade

Cardiac tamponade can be a life-threatening event. Increasing fluid and pressure in the pericardium reduces atrial and ventricular filling. As filling is reduced, stroke volume and cardiac output fall, with associated hypotension leading to cardiac arrest. Rapid diagnosis and drainage of the pericardial fluid are required to avoid cardiovascular collapse.

Pericardiocentesis guided by echocardiography is a safe and effective method of relieving tamponade in a nonarrest setting, especially when used in conjunction with a pericardial drain, and may obviate the need for subsequent operating room treatment.1-5

In the arrest setting, in the absence of echocardiography, emergency pericardiocentesis without imaging guidance can be beneficial. (Class IIa, LOE C)

Emergency department thoracotomy may improve survival compared with pericardiocentesis in patients with pericardial tamponade secondary to trauma who are in cardiac arrest or who are prearrest,6-8 especially if gross blood causes clotting that blocks a pericardiocentesis needle.9 (Class IIb, LOE C)

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References

  1. Maggiolini S, Bozzano A, Russo P, Vitale G, Osculati G, Cantu E, Achilli F, Valagussa F. Echocardiography-guided pericardiocentesis with probe-mounted needle: report of 53 cases. J Am Soc Echocardiogr. 2001;14:821–824.
  2. Salem K, Mulji A, Lonn E. Echocardiographically guided pericardiocentesis: the gold standard for the management of pericardial effusion and cardiac tamponade. Can J Cardiol. 1999;15:1251–1255.
  3. Susini G, Pepi M, Sisillo E, Bortone F, Salvi L, Barbier P, Fiorentini C. Percutaneous pericardiocentesis versus subxiphoid pericardiotomy in cardiac tamponade due to postoperative pericardial effusion. J Cardiothorac Vasc Anesth. 1993;7:178–183.
  4. Tsang TS, Barnes ME, Gersh BJ, Bailey KR, Seward JB. Outcomes of clinically significant idiopathic pericardial effusion requiring intervention. Am J Cardiol. 2003;91:704–707.
  5. Tsang TS, Enriquez-Sarano M, Freeman WK, Barnes ME, Sinak LJ, Gersh BJ, Bailey KR, Seward JB. Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc. 2002;77:429–436.
  6. Coats TJ, Keogh S, Clark H, Neal M. Prehospital resuscitative thoracotomy for cardiac arrest after penetrating trauma: rationale and case series. J Trauma. 2001;50:670–673.
  7. Powell DW, Moore EE, Cothren CC, Ciesla DJ, Burch JM, Moore JB, Johnson JL. Is emergency department resuscitative thoracotomy futile care for the critically injured patient requiring prehospital cardiopulmonary resuscitation? J Am Coll Surg. 2004;199:211–215.
  8. Lewis G, Knottenbelt JD. Should emergency room thoracotomy be reserved for cases of cardiac tamponade? Injury. 1991;22:5–6.
  9. Wang JC, Jiang P, Huang J, Qian GS. The protective effects and mechanisms of peroxisome proliferator-activated receptor-gamma agonist in rats with acute lung injury [in Chinese]. Zhonghua Jie He He Hu Xi Za Zhi. 2008;31:425–430.
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Cardiac Arrest Caused by Cardiac Tamponade

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