Pericardiocentesis in an Ambulance: A Case Report and Lessons Learned

There are few procedures performed in the prehospital setting as intimidating as pericardiocentesis. We report a case in which lifesaving pericardiocentesis was performed in the back of an ambulance after temporizing measures of volume resuscitation and vasopressor therapy failed. Fluid accumulation within the pericardial sac can increase pressures around the heart and lead to cardiac tamponade. Helicopter emergency medical service crews may be called to transport patients with cardiac tamponade physiology to definitive care where removal of the pericardial fluid can be achieved. Pericardiocentesis is indicated as an emergency procedure in patients with hemodynamic compromise secondary to cardiac tamponade.¹ Because most HEMS crews do not routinely perform pericardiocentesis because of the rare need or crew scope of practice limitations, the general approach to management in the prehospital setting is volume resuscitation, to overcome decreased preload, and vasopressor support. Here, we report a case in which lifesaving pericardiocentesis was performed in a ground ambulance after temporizing measures of volume resuscitation and vasopressor therapy failed.