A novel in-plane technique ultrasound-guided pericardiocentesis via subcostal approach

Cardiac tamponade occurs when fluid or blood, fills the pericardial space, and causes hemodynamic compromise due to compression of the heart. It is a potentially life-threatening condition, that requires rapid recognition and immediate treatment. Formerly, blind or surgical techniques were used, and it is associated with complications. Medical technology development has enabled us to perform the procedure safely, with the assistance of ultrasound devices. This article will highlight the novel use of an in-plane subcostal technique, as a safe option for pericardiocentesis in cardiac tamponade.

A 50-year-old man presented to the emergency department (ED) with shortness of breath and shock. He was intubated for respiratory distress. His bedside echocardiography showed cardiac tamponade. Ultrasound-guided pericardiocentesis was carried out using an in-plane technique, at the subcostal region, with a high-frequency linear ultrasound transducer. This particular method provided full visualization of needle trajectory throughout the procedure. It was successfully completed with no complications and patient's hemodynamic status improved post-procedure. He was successfully discharged on day 13.

The in-plane subcostal pericardiocentesis is a safe, and simple approach that can be performed in the ED for patients with cardiac tamponade. We recommend this new in-plane method, with high-frequency linear transducer at the subcostal area as an alternative when cardiac window for other approaches cannot be visualized.