Related Experiment Video
Updated: Mar 26, 2026
Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
Blind subxiphoid pericardiotomy to relieve critical acute hemopericardium: a final report
Y Kurimoto1, K Maekawa2, K Tanno2
1Department of Traumatology and Acute Care Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan. kurimoto@sapmed.ac.jp.
Insights
Blind subxiphoid pericardiotomy (BSP) offers a safe and effective emergency treatment for cardiac tamponade due to hemopericardium. This rapid procedure showed superior outcomes compared to percutaneous catheter drainage (PCD), with fewer complications and improved survival rates.
Area of Science:
- Cardiology
- Emergency Medicine
- Thoracic Surgery
Background:
- Acute cardiac tamponade is a life-threatening condition requiring prompt intervention.
- Percutaneous catheter drainage (PCD) is a standard treatment but can be time-consuming and less effective in cases of clotted hemopericardium.
- Conventional subxiphoid pericardiotomy, while effective for clotted effusions, has been perceived as too slow for emergency use.
Purpose of the Study:
- To evaluate the safety and efficacy of a modified blind subxiphoid pericardiotomy (BSP) technique for emergency management of cardiac tamponade.
- To compare the outcomes of BSP with conventional percutaneous catheter drainage (PCD) in patients with acute hemopericardium.
Main Methods:
- A prospective observational study was conducted on 148 emergency patients with acute hemopericardium.
- Patients were divided into two groups: BSP (n=53) and PCD (n=95).
- Causes of hemopericardium included trauma, acute aortic disease, and cardiac rupture post-myocardial infarction.
Main Results:
- BSP successfully relieved cardiac tamponade in all 53 patients, whereas PCD was ineffective in 12.6% (p=0.008).
- Procedure-related complication rates were significantly lower for BSP (0%) compared to PCD (16.8%, p=0.002).
- Survival rates were higher in the BSP group (18.9%) than in the PCD group (6.3%, p=0.018).
Conclusions:
- Blind subxiphoid pericardiotomy (BSP) is a safe and effective emergency procedure for cardiac tamponade resulting from acute hemopericardium.
- The effectiveness of BSP is attributed to its ability to manage clotted hemopericardium, a challenge for PCD.
- Non-specialist physicians have successfully performed BSP without complications, highlighting its potential for broader application in critical care settings.
Purpose:
Percutaneous catheter drainage (PCD) has been considered a standard method of relieving acute cardiac tamponade. Although conventional subxiphoid pericardiotomy is useful even for clotted hemopericardium, it has been believed to be unsuitable for emergency treatment because it is a time-consuming procedure. We report our modified pericardiotomy technique that can be used for emergency management.
Methods:
We designed a prospective observational study to evaluate blind subxiphoid pericardiotomy (BSP) for critical cardiac tamponade due to hemopericardium. Emergency patients (n = 148) with acute hemopericardium secondary to trauma (n = 12), acute aortic disease (n = 122), or cardiac rupture following acute myocardial infarction (n = 14) were the subjects. Early results were compared between the BSP group (n = 53) and the PCD group (n = 95).
Results:
BSP was effective at relieving cardiac tamponade in all 53 cases, but PCD was ineffective in 12 cases (12.6 %, p = 0.008). Procedure-related complication rates of BSP and PCD were 0 and 16.8 %, respectively (p = 0.002). Survival rates for the BSP and PCD groups were 18.9 and 6.3 %, respectively (p = 0.018). Since 2005, when we discarded the restriction that only board-certified surgeons should perform BSP, acute care physicians (including trainees) have performed BSP for 22 patients without procedure-related complications.
Conclusions:
BSP was safe and effective for cardiac tamponade due to acute hemopericardium. Critical complications during PCD for hemopericardium could not be avoided in some cases because of clots in the pericardium.
