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Blind subxiphoid pericardiotomy for cardiac tamponade because of acute hemopericardium

Yoshihiko Kurimoto1, Mamoru Hase, Satoshi Nara

  • 1Department of Traumatology and Critical Care Medicine, Sapporo Medical University, Sapporo, Japan. kurimoto@sapmed.ac.jp

The Journal of Trauma
|September 13, 2006
PubMed

Insights

Blind subxiphoid pericardiotomy (BSP) is a safe and rapid emergency procedure for hemopericardium, outperforming percutaneous catheter drainage (PCD) which risks complications like clotting and catheter occlusion.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Surgical Procedures

Background:

  • Hemopericardium can lead to cardiac tamponade, a life-threatening condition.
  • Percutaneous catheter drainage (PCD) for hemopericardium has limitations, including potential catheter occlusion and cardiac perforation.
  • Rapid intervention is crucial in emergency cases of cardiac tamponade due to hemopericardium.

Purpose of the Study:

  • To evaluate the effectiveness and safety of blind subxiphoid pericardiotomy (BSP) as an emergency procedure for hemopericardium.
  • To compare BSP with percutaneous catheter drainage (PCD) in managing cardiac tamponade secondary to various causes.
  • To determine a favorable management strategy for hemopericardium-induced cardiac tamponade.

Main Methods:

  • A prospective control study was conducted comparing BSP (n=16) and PCD (n=67) for cardiac tamponade from hemopericardium.
  • Patients presented with cardio-pulmonary arrest (CPA) or near CPA due to trauma, acute aortic dissection, or myocardial infarction.
  • BSP was performed by board-certified surgeons, while PCD was managed by emergency physicians, with or without local anesthesia.

Main Results:

  • Blind subxiphoid pericardiotomy (BSP) was effective in all cases, whereas PCD failed in five cases due to pericardial clotting.
  • The BSP group experienced no complications, contrasting with five critical and three infeasible drainage complications in the PCD group.
  • Survival rates were comparable between groups (4/16 in BSP vs. 6/67 in PCD), though BSP showed a trend towards better outcomes.

Conclusions:

  • Blind subxiphoid pericardiotomy (BSP) is a safe, rapid, and effective emergency procedure for hemopericardium.
  • Percutaneous catheter drainage (PCD) is associated with significant complications, particularly due to pericardial clotting.
  • BSP offers a valuable alternative for immediate management of cardiac tamponade in emergency settings.
Abstract

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