Intra-pericardial thrombin injection as bailout strategy in iatrogenic pericardial tamponade.

Abstract

Cardiac tamponade is arare but life-threatening complication of cardiac interventions. Despite prompt pericardiocentesis, clinical management can be challenging and sometimes haemodynamic stabilisation is difficult to achieve. Intra-pericardial thrombin injection after pericardiocentesis promotes haemostasis and acts as asealing agent, as previously described for left ventricular free-wall rupture. We aimed to evaluate intra-pericardial thrombin injection as abailout strategy for pericardial tamponade following percutaneous cardiac interventions. In a5-year single-centre retrospective analysis we identified 31patients with cardiac tamponade due to percutaneous intracardiac procedures. Intra-pericardial thrombin injection as abailout strategy was administered in 5of 31patients (16.1%). Patients receiving intra-pericardial thrombin were in amore critical state when thrombin was applied, as demonstrated by ahigher rate of resuscitation (40% versus 26.9%) and atrend toward aprolonged stay in the intensive care unit (177.6 ± 84.0 vs 98.0 ± 31.4 h). None of the patients with pericardial tamponades treated with intra-pericardial thrombin needed cardiothoracic surgery. Mortality after 30days was lower with intra-pericardial thrombin injection than with standard treatment (0% vs 15.4%). We observed no complications using intra-pericardial thrombin. Intra-pericardial thrombin injection could be considered as abailout strategy for patients with iatrogenic pericardial tamponade due to percutaneous procedures. We recommend further evaluation of this technique in the clinical management of refractory pericardial tamponade.