Abstract 13023: Contemporary Echocardiography-Guided Pericardiocentesis Outcomes in a High-Volume Tertiary Teaching Hospital

Abstract

Introduction: First performed in the 1970s, echo-guided pericardiocentesis has become the preferred approach for draining pericardial effusions. After identifying the largest pocket, a cardiology attending and fellow use a micropuncture needle kit, confirm placement with agitated saline, and leave a side and end hole 8 French drain stocked with sterile saline. This is drained every 8 hours by nursing and never left to gravity or else it tends to clot. The drain is removed when output is <25 cc in 24 hours, or by 7 days. Methods: We prospectively maintained an IRB approved database of pericardiocenteses performed by three experienced cardiology attendings directly supervising a multitude of fellows between 2009-2021 at Thomas Jefferson University Hospital. Results: Of 391 pericardiocenteses, 61% were for tamponade. 66% were done from an apical approach, 18% subcostal, 11% left parasternal, and 2% right parasternal. Drains were left in for an average of 3.1 days (range 1-10 days). An average of 578 mL were drained with the initial procedure (range 5-2670 mL), and 62% of effusions were bloody. A total of 42% were deemed idiopathic, without an identifiable cause, 27% were associated with malignancy (56% of these had positive cytology with remaining unlikely from any other cause), 9% after open heart surgery (valve replacement, heart transplant, dissection repair), 8% post-procedural (electrophysiology, cardiac catheterization, line placement), 5% were in chronic dialysis patients, and the remainder were due to a combination of hemorrhage not related to a procedure, rheumatic, post-radiation, or medication-induced. The rate of serious complications was 3% and included 4 pneumothoraces, 3 hemothoraces, 3 cases of pericardial decompression syndrome, 1 RV microperforation, and one PEA arrest resulting from cardiac perforation. There were no mortalities. The rate of non-serious complications was 4% and included pleural placement of drain in 8, severe pain remitting with drain removal in 5, prolonged bleeding from puncture site in 2, and SVT during placement in 1. Conclusion: Overall, echocardiography-guided pericardiocentesis by experienced providers supervising fellows-in-training is a safe and effective means of draining pericardial effusions.