IntroductionDespite its importance, comprehensive contemporary data on pericardiocentesis (PC) outcomes, etiologies, and prognostic indicators remain limited.AimWe aimed to evaluate the etiologies, pericardial fluid characteristics, and in-hospital and total mortality rates in patients who underwent PC in our center. Additionally, we sought to identify factors associated with total mortality.Material and methodsWe conducted a single-center retrospective study that included patients who underwent PC performed with the fluoroscopy-guided subxiphoid approach in the catheterization laboratory in our center between November 2019 and November 2024. The patients were classified into two groups: survivors and non-survivors.ResultsA total of 127 patients were included in this study. The median follow-up was 16 months. In-hospital mortality occurred in 27 (21.3%) patients, and total mortality occurred in 56 (44.1%) patients during follow-up. The most common etiology was malignancy, accounting for 34.6%, followed by idiopathic causes (33.9%). Malignant etiology, presentation with pericardial tamponade, and low albumin levels were found to be independent predictors of mortality (p < 0.001, p = 0.007, p = 0.026, respectively). Malignant pericardial effusion (PE) had a worse prognosis according to the Kaplan-Meier survival curve analysis (log-rank p < 0.001).ConclusionsUnderstanding etiologies is crucial for the prognosis and management of PE. Malignant PE had a worse prognosis compared with non-malignant PE. Therefore, in addition to cytological analysis of the pericardial fluid, the use of advanced imaging methods plays a pivotal role in the evaluation of malignancy, especially in patients without a known malignancy, as PE may be the first sign of cancer.

ABSTRACTPurpose:To develop a pericardiocentesis (PCT) simulation model applied for undergraduate medical training.Methods:A PCT simulator consisted of a torso mannequin, a silicone rubber heart (SRH), a container, and a filling system. The mannequin was submitted to a coronal section and an 18 × 18-cm precordial area opening. The SRH was prepared in accordance with structural dimensions of a normal heart. The elaboration of a structure container to simulate the pericardial cavity consisted of a non-leakable unit inside a cardboard (PcavBox). The PcavBox filling system was connected to a 10-mm diameter tube and a total of 2.5 L of saline solution. This structure was adapted inside the mannequin and covered with a thermoformable rubber material of 2 mm in skin color. For PCT simulation, we used a 10-mL syringe connected to a 14G needle for an imaging guided puncture facilitated by a portable ultrasound.Results:A SRH was successfully developed and fixed inside the Pcav Box, connected to the fluid pressure system. It was able to simulate a cardiac tamponade scenario identified by ultrasound. A series of 50 punctures was successively performed without liquid leak.Conclusion:A low-cost PCT simulator was developed and coan be applied to healthcare education.

Abstract Introduction Pericardial effusion (PE) is a complication of neoplastic processes that worsens the prognosis and can lead to symptomatic presentations requiring pericardiocentesis (PC). There is limited literature regarding the evolution of PE from its onset to the need for PC, characteristics of these patients, progression rate of PE, and potential accelerating factors. Purpose This study aims to: i) Analyze the baseline characteristics of patients undergoing PC; ii) Evaluate the correlation between PE appearance and cytology; iii) Analyze the progression rate until PC performance. Methods This retrospective observational study includes patients with active neoplasia and significant symptomatic PE treated with PC at our hospital from 01/01/2010 to 06/30/23, with subsequent follow-up until 10/31/23. Clinical characteristics related to neoplastic processes and PE diagnosis were analyzed, including PE appearance, cytology, and computed tomography scans performed as neoplasia follow-up prior to PC. Results A total of 75 patients were included, with 6 excluded because of non-malignant conditions (2 acute pericarditis-related PE, 3 purulent PE, and 1 chylous PE). The remaining 69 patients had a median age of 59 years, with 55.1% being male. Lung neoplasm was most frequent (63.8%, with 84% adenocarcinoma), followed by lymphomas/lymphoid leukemia (7.3%), upper digestive tract (7.3%), and breast cancer (7.3%). 52.2% of PEs undergoing PC were diagnosed simultaneously with neoplasm (70.45% associated with pulmonary neoplasms); 43.5% had ECOG 1, and 89.9% had metastases (excluding PE) at PC. Cardiac tamponade was present in 27.5%, with percutaneous pericardiostomy added in 21.7%. PE appearance was sero-haematic in 49.3%, haematic in 36.2%, and serous in 14.5%. Cytology showed mostly positive results (69.2%: 50% in serous PE and 71.93% in haematic/sero-haematic PE). The median time from the last CT scan prior to PE to PC was 5 months (160 days, range: 24-943 days). PC recurrence was observed in 30.4% of cases. Follow-up mortality was 82.6%, higher in breast, renal, digestive, thymoma, and genital neoplasms (100%), with hematological neoplasms having the lowest mortality (40%), followed by pulmonary neoplasms (79.5%). Mortality was higher in patients with more lines of treatment at PC and with a higher number of metastases. The median time from PC to death was 2 months (68.5 days, range: 1 day-2007 days). Conclusions The most common neoplastic PE was associated with lung adenocarcinoma, though a variety of neoplasms were observed. Half of PEs were diagnosed concurrently with neoplasm diagnosis. Cytology sensitivity was not high, and PE appearance did not adequately predict outcomes. The median time from the last CT scan prior to PE to PC was 5 months, potentially guiding echocardiographic follow-up once PE is observed on CT. Overall mortality was high (82.6%), except for onco-hematological PE.Iconographic summary of malignant PE

Pericardiocentesis Outcomes in Patients With Pulmonary Hypertension: A Nationwide Analysis from the United States

Introduction: Some causes of cardiac arrest, e.g. cardiac tamponade or tension pneumothorax, can only be reversed by an emergent invasive procedure; identification and treatment of these causes is critical during cardiopulmonary resuscitation. The use of emergent procedural interventions has not been comprehensively studied in the setting of in-hospital cardiac arrest (IHCA). Methods: Using the American Heart Association sponsored Get With The Guidelines ® -Resuscitation registry, we examined adult patients who received an invasive procedure (chest tube insertion (CTI), needle thoracostomy (NT), and/or pericardiocentesis (PC)) during IHCA between 2001 and 2020. Groups were compared using Fisher’s exact test for categorical variables and t-test or rank-sum for continuous variables. Outcomes were compared using multivariate hierarchical modeling accounting for clustering by hospital. Results: Of the 482,972 patients with IHCA, 11,304 (2.34%) had a procedure performed (1.24% CTI, 0.46% NT, 0.63% PC). PEA was a more likely initial rhythm in those who received a procedure compared to those who had no procedure (58.2% vs 47.8%, p&lt;0.01), and VT or VF was less likely (8.8% vs 16.9%, p&lt;0.01). Peri-arrest myocardial infarction was more likely in those who received PC compared to no procedure (21.7% vs 15.0%, p&lt;0.01). Those who received CTI or NT were more likely to be on a ventilator than those with no procedure (67.9% vs 49.7%, p&lt;0.01). The mean duration of resuscitation was longer for those with CTI, NT, and PC (29.0 min, 29.0 min, and 33.6 min) than for those who had no procedure (18.6 min, p&lt;0.01). Patients who received CTI, NT, and PC had 7%, 20%, and 27% lower odds of ROSC respectively than patients who had no procedure (aOR 0.93, 95%CI 0.91 - 0.95, p&lt;0.01; aOR 0.80, 95%CI 0.78 - 0.82, p&lt;0.01; aOR 0.73, 95%CI 0.71 - 0.74, p&lt;0.01), and 5%, 10%, and 12% lower odds of survival to discharge (aOR 0.95, 95%CI 0.94 - 0.96, p&lt;0.01; aOR 0.90, 95%CI 0.89 - 0.92, p&lt;0.01; aOR 0.88, 95%CI 0.87 - 0.89, p&lt;0.01). Conclusions: We found important differences in patient characteristics and outcomes for those who received invasive procedures compared to those with no procedure. Those who received invasive procedures during IHCA had longer resuscitations but less ROSC and survival to discharge.

Abstract Background Neoplastic pericardial effusion (NPE) is a serious complication that occurs in the setting of advanced oncological disease and is associated with a high recurrence rate. Currently, pericardiocentesis (PCT) remains the first therapeutic option and the use of percutaneous balloon pericardiotomy (PBP) is limited to the treatment of recurrences. However, it is not known whether some aspects of the procedure during PBP lead to different outcomes in terms of survival and recurrence, and no such patients have been included in studies during COVID-19 pandemic. Purpose The aim is to analyses the success, complications and recurrence rate (defined as recurrence of NPE requiring PCT, PBP or surgical pericardial window (SPW) of both procedures (BP) in order to establish the optimal entry treatment for these patients. Methods This research analyzed the clinical characteristics and prognostic factors of patients with severe pericardial effusion of neoplastic etiology who underwent PBP during the COVID-19 pandemic. A prospective study was conducted involving 23 patients admitted between January 2020 and January 2022 for severe NPE who underwent PCT or PBP as initial treatment of NPE. Results We included 23 patients, 62.9% were male with a mean age of 51.2±14.9 years NPE was the first manifestation of the oncological process in 12 patients (52.1%) with lung cancer being the most frequently associated primary cancer (58.7%) followed by breast cancer in 12.7% of cases. A total of 26 procedures were performed, 10 PCT, 15 PBP, 1 SPW, with tumors cells identified in the pericardial fluid in 13.0% of cases. PCT was used as an entry point in 10 patients (43.5%), 6 patients were COVID-19 positive and PCT was performed as the first treatment. While PBP was chosen as the first therapeutic option in 13 patients (56.5%) (2 Re-PBP). The initial efficacy of the procedure was 93.1% and 92.2% respectively (p=0.88), with 1 complication occurring in the PBP group but not requiring scheduled SPW. In the former group, the percentage of recurrences was higher (34.7%; 8 recurrences in 10 patients) compared to patients treated with upfront PBP (8.6%; 2 recurrences in 13 patients), p=0.09. In addition, only one patient had to resort to surgery. When analyses according to the BP. used, the recurrence rate was 4.0 times higher for PCT (34.7 vs. 8.6% recurrences), although without reaching statistical significance (p=0.16). Conclusions The PBP is a simple, safe and effective technique for the treatment of NPE during the COVID-19 pandemic, in our series it was associated with a lower recurrence rate. Therefore, it could replace PCT in these patients during the COVID-19 pandemic as optimal first line treatment, providing better quality of life and reducing the need for re-interventions. Funding Acknowledgement Type of funding sources: None.

AimThis study investigated the factors predicting survival and the recurrence of pericardial effusion (PE) requiring pericardiocentesis (PCC) in patients with cancer.Materials and MethodsWe analyzed the data of patients who underwent PCC for large PEs from 2010 to 2020 at The University of Texas MD Anderson Cancer Center. The time to the first recurrent PE requiring PCC was the interval from the index PCC with pericardial drain placement to first recurrent PE requiring drainage (either repeated PCC or a pericardial window). Univariate and multivariate Fine-Gray models accounting for the competing risk of death were used to identify predictors of recurrent PE requiring drainage. Cox regression models were used to identify predictors of death.ResultsThe study cohort included 418 patients with index PCC and pericardial drain placement, of whom 65 (16%) had recurrent PEs requiring drainage. The cumulative incidences of recurrent PE requiring drainage at 12 and 60 months were 15.0% and 15.6%, respectively. Younger age, anti-inflammatory medication use, and solid tumors were associated with an increased risk of recurrence of PE requiring drainage, and that echocardiographic evidence of tamponade at presentation and receipt of immunotherapy were associated with a decreased risk of recurrence. Factors predicting poor survival included older age, malignant effusion on cytology, non-use of anti-inflammatory agents, non-lymphoma cancers and primary lung cancer.ConclusionAmong cancer patients with large PEs requiring drainage, young patients with solid tumors were more likely to experience recurrence, while elderly patients and those with lung cancer, malignant PE cytology, and non-use of anti-inflammatory agents showed worse survival.

BackgroundWhile institutional series have sought to define the optimal strategy for drainage of pericardial effusions, large-scale comparisons remain lacking. Using a nationally representative sample, the present study examined clinical and financial outcomes following pericardiocentesis (PC) and surgical drainage (SD) in patients admitted for pericardial effusion and tamponade.MethodsAdults undergoing PC or SD within 2 days of admission for non-surgically related pericardial effusion or tamponade were identified in the 2016–2019 Nationwide Readmissions Database. Multivariable logistic and linear models were developed to evaluate the association between intervention type and outcomes. The primary outcome of interest was mortality while secondary endpoints included reintervention, periprocedural complications, hospital length of stay (LOS), hospitalization costs and 30-day non-elective readmission.ResultsOf an estimated 44,637 records meeting inclusion criteria, 28,862 (64.7%) underwent PC while the remainder underwent SD for initial management of pericardial effusion or tamponade. PC was associated with significantly increased odds of in-hospital mortality, reintervention and 30-day readmission relative to SD. PC was also associated with greater odds of cardiac complications but lower odds of infection, respiratory failure and blood transfusions compared to SD. Although PC was associated with shorter index hospital length of stay and costs, the two strategies yielded similar 30-day cumulative costs.ConclusionManagement of pericardial effusion with PC is associated with greater odds of mortality, reintervention and 30-day readmission but similar 30-day cumulative costs compared to SD. In the setting of adequate hospital capability and operator expertise, SD is a reasonable initial treatment strategy for pericardial effusion.

AimTo compare the prognostic impact of pericardiocentesis (PCC) and surgical pericardiotomy (SP) in blunt traumatic pericardial tamponade.MethodsAmong 361,706 trauma patients registered in the Japan Trauma Data Bank from January 2004 to December 2018, we included those with blunt traumatic cardiac tamponade who underwent PCC and/or SP. We excluded patients with penetrating trauma, age younger than 15 years, Injury Severity Score (ISS) equal to 75, blood pressure 0 mmHg at the time of admission, head Abbreviated Injury Scale (AIS) score 5 or more, and those with missing data for outcomes. To examine the effect of SP, patients were divided into a PCC group and an SP‐only group. Missing values of age, sex, systolic blood pressure, respiratory rate, pulse rate, time from emergency call to hospital arrival, head AIS, chest AIS, abdomen/pelvis AIS, Glasgow Coma Scale score, and ISS were estimated using multiple imputation. In‐hospital mortality was analyzed using multivariable analysis, and we undertook a survival analysis.ResultsWe analyzed 305 patients, 150 (49.2%) in the PCC group and 155 (50.8%) in the SP‐only group. The in‐hospital mortality rate was 40.7% in the PCC group and 76.8% in the SP‐only group. Multivariable analysis after multiple imputation showed an odds ratio of SP for in‐hospital mortality 5.34 (95% confidence interval, 2.80–10.18; P < 0.01) compared with PCC. Using the Kaplan–Meier method, SP showed a significant risk of mortality (hazard ratio 2.16; 95% confidence interval, 1.58–2.95; P < 0.01).ConclusionsIn patients with blunt traumatic cardiac tamponade, SP was associated with poor prognosis.

Rotational atherectomy (RA) has been described in case reports to be effective in ablating under-expanded stents. We present a case of calcified bifurcation lesion percutaneous coronary intervention (PCI), in which the branch stent protruding into main branch blocked the balloon getting through, and the following RA led to pericardial tamponade. The first stent was deployed from the proximal of left anterior descending artery (LAD) to the proximal of diagonal for an 80-year-old man who suffered from non-ST-elevation myocardial infarction to make a Culotte dual stent PCI. The operator failed to make balloon get through the struts protruding into LAD lumen anyway. After RA drill through the LAD lumen, it showed an excellent angiographic outcome. Stent deployment in LAD was successful, but pericardial tamponade occurred in a short time. After pericardiocentesis was performed under fluoroscopic guidance, the patient was uneventful. After 1 year, the follow-up coronary computed tomography (CT) angiography showed no in-stent restenosis, stent fracture or disrupted struts protruding outside of the vessel’s outline of LAD and the first diagonal (D1). This case shows stents’ RA could be dangerous in grinding across the stents’ lateral hole in an unsymmetrical lumen. Although RA could be a useful remedy in the situation of under-expansion of implanted stents, the debulking should be performed for longitudinal stent ablation and cautiously performed for bifurcation lesion in which the protruding stents from side branch were unsymmetrically blocking the path. J Med Cases. 2021;12(6):230-232 doi: https://doi.org/10.14740/jmc3678

Pericardial effusion caused by central venous catheterization mostly occurs in the early stage of catheterization and has critical clinical manifestations. Pericardiocentesis is required for cardiac tamponade, and early diagnosis and intervention can effectively improve prognosis.

HEMATOLOGICAL MALIGNANCIES WITH THROMBOCYTOPENIA UNDERGOING PRIMARY PERCUTANEOUS PERICARDIOCENTESIS: PERIPROCEDURAL (30-DAY) OVERALL SURVIVAL ANALYSIS

BACKGROUND: The standard approach to pericardiocentesis is a subcostal approach with echocardiographic guidance. Hepatomegaly and noncircumferential effusions warrant nonstandard approaches to drain effusions; echocardiographic guidance has made other, less traditional, non-subcostal approaches feasible. METHODS: All pediatric patients undergoing pericardiocentesis from August 2008 to June 2016 at a tertiary care hospital were included. Procedure-related complications, approach to procedure, the location …

A patient suffered from cardiac rupture and pericardial tamponade during atrial flutter ablation and then treated with emergent pericardiocentesis and thoracotomy for repairing the cardiac injury. Pericardial tamponadehas a high mortality. Tansesophageal echocardiography can be adopted to determine the volume of blood in the pericardium and the effect of hemostasis, as well as maintain circulation stability. Delayed abdominal hemorrhage after pericardial tamponade is rare which is usually missed diagnosed and misdiagnosed. Combined with transesophageal echocardiography and bedside ultrasonography, the secondary pericardial tamponade can be excluded as early as possible. It is of great significance for anesthesiologists and intensive care unit (ICU) doctors to master the ultrasonic monitoring technique. Key words: Atrial flutter; Radiofrequency ablation; Pericardial tamponade; Delayed abdominal hemorrhage

Background: Pericardial effusion may culminate in cardiac tamponade which could be fatal. This study aims to describe the prevalence of cardiac tamponade, with the etiology, and outcome of childhood pericardial effusion at Aminu Kano Teaching Hospital, Kano, Nigeria. Materials and Methods: Hospital records of children with pericardial effusion were retrospectively analyzed from June 2016 to May 2018. Data were described via percentages, tables, and bar and pie charts. Results: Of the 5876 pediatric admissions during the study duration, 10 (0.2%) children presented with cardiac tamponade (9 boys and 1 girl) and had emergency echocardiography-guided percutaneous pericardiocentesis; 5 (50%) of them had purulent, 4 (40%) had serous, and 1 (10%) had hemorrhagic pericardial effusion. Seventeen children, aged 8 months to 13 years with a male: female ratio of 2.4:1, had pericardial effusion during the study period. Pericardial effusion of infectious origin (58.8%) was the most common followed by uremic (17.4%), rheumatic (11.8%), and trauma and idiopathic (5.9%). Tuberculosis (TB) was the most implicated cause of infectious pericardial effusion (70%), and also the most common cause of cardiac tamponade (50%). Mortality was recorded in two children (11.8%) with end-stage renal disease and decompensated rheumatic heart disease, both complicated by pericardial effusion. None of them were in tamponade and hence did not have pericardiocentesis. Emergency echocardiography-guided percutaneous pericardiocentesis was safe and successful in all those who had this procedure. Conclusion: Cardiac tamponade is common in children with pericardial effusion in Kano. TB is the leading cause of childhood pericardial effusion and cardiac tamponade. Mortality was reported in two children, with pericardial effusion of uremic and rheumatic etiology each.

Objective: Surgical pericardial fenestration (sPF) is more invasive than interventional pericardiocentesis (PC) and requires general anesthesia. Severe complications such as ventricular puncture and chamber lacerations are, however, reported in association with PC and not with sPF. Is survival after sPF only determined by nonsurgical factors? Methods: Between July 2000 and December 2015, data of all patients who had undergone sPF—either thoracoscopically or by anterior mini-thoracotomy—were investigated. The 2 techniques were analyzed retrospectively and the outcome (effectiveness, change in shock index) and the survival were assessed. Results: 32 patients underwent 33 sPF. One-half of the patients had a benign underlying disease; the other half suffered from a malignant tumor. Four procedures were performed thoracoscopically and 29 via mini-thoracotomy. Both techniques were hemodynamically effective (P &amp;lt; 0.0001) in increasing blood pressure and decreasing pulse rate). There was no death due to failure to control the pericardial effusion and no procedure related mortality. Of the 16 patients with benign underlying disease 14 (87.5%) are still alive. Two died due to reasons unrelated to the procedure or the underlying disease. All 16 patients (100%) with malignant underlying disease died due to tumor progression. Conclusions: In our patient cohort minimally invasive thoracic PF was safe and effective. The survival in our study was only related to the nature of the underlying disease. We conclude that sPF is an excellent procedure to treat pericardial effusions: both examined surgical techniques, thoracoscopic video assisted and access via mini-thoracotomy, were equally effective and safe.

What do you know about pericardiocentesis?

Percutaneous coronary intervention (PCI), despite its remarkable efficacy in the treatment of coronary artery disease, has some complications such as coronary artery perforations, which are uncommon but may lead to pericardial effusion and progress to cardiac tamponade, myocardial infarction, and death. A 76-year-old woman with a history of exertional angina was admitted to our hospital for PCI. The angiographic feature of the patient's PCI was a major dye leakage into the pericardial sac with a frank perforation, representing Type III Ellis classification. Given her unstable hemodynamic state and a high risk for perforation, immediate pericardiocentesis was performed and a JoStent GraftMaster Stent was used. In addition, a decision was made to perform a covered stent implantation, as an alternative to surgery, because balloon dilation failed to stop the leakage. The perforation was sealed successfully. After the pericardiocentesis and the emergency covered stent implantation, the patient was stable and her hemodynamic state improved gradually. Coronary artery perforations with sequelae during the intervention, albeit a rare event, may lead to serious complications and even death. While prompt surgical intervention may be life-saving, expertise in the use of covered stents may provide a valuable rescue option for this serious complication.

Pericardiocentesis (PC) is both a diagnostic and a potentially life-saving therapeutic procedure. Currently echocardiography-guided pericardiocentesis is considered the standard clinical practice in the treatment of large pericardial effusions and cardiac tamponade. Although considered relatively safe, this invasive procedure may be associated with certain risks and potentially serious complications. This review provides a summary of pericardiocentesis and a focused overview of the potential complications of this procedure.

The safety and optimal strategy of the use of dabigatran versus uninterrupted warfarin in atrial fibrillation ablation is currently unclear. We performed a retrospective analysis between July 2011-October 2012 of all patients undergoing an AF ablation who received uninterrupted warfarin therapy (199) and the routine cessation of Dabigatran therapy (126) 4 days pre-ablation. Major safety endpoints included: pericardial effusion (requiring pericardiocentesis), peripheral thromboembolism, CVA, and groin hematoma requiring blood transfusion. Minor endpoints included pericardial effusion and groin hematoma. Dabigatran was restarted the following day after ablation. The warfarin group was older, had a higher CHADS2, CHA2DS2VASc and HASBLED scores and greater prevalence of aortic plaque. The major complication rate was 2.0% in the warfarin group and 2.4% in the dabigatran group (P= 0.83). The minor complication rate was 2.5% in the warfarin group and <1% in the dabigatran group (P= 0.27). In the dabigatran group, there was one renal thromboembolic event 4 days post-ablation. All patients in the warfarin group who suffered a major complication required a blood transfusion. Cessation of dabigatran therapy 4 days pre AF ablation has a comparable safety profile to uninterrupted warfarin therapy.