Pericardiocentesis During Transport for Cardiac Tamponade Complicating Acute Type A Aortic Dissection

Area of Science:

• Emergency Medicine
• Critical Care Transport
• Point-of-Care Ultrasound

Background:

• Bedside ultrasound (BUS) is a valuable tool in emergency medicine, with increasing application in critical care transport.
• Survival Flight, a critical care transport program, began training flight nurses in BUS use in 2014.
• Nurses trained in procedures like pericardiocentesis can perform them with medical direction using devices like Butterfly IQ+.

Observation:

• Pericardiocentesis is a potentially lifesaving procedure for pericardial tamponade.
• Its use in tamponade secondary to thoracic aortic dissection is controversial due to risks of exacerbating the dissection.
• Two cases of in-transport, ultrasound-guided pericardiocentesis for tamponade from type A aortic dissection are presented.

Findings:

• Ultrasound-guided pericardiocentesis was successfully performed during inter-facility transport for two patients with cardiac tamponade secondary to type A aortic dissection.
• The procedure was guided by flight nurses utilizing Butterfly IQ+ devices.
• This demonstrates the feasibility of performing this intervention in the transport environment.

Implications:

• Ultrasound-guided pericardiocentesis may be a viable intervention for managing cardiac tamponade in patients with type A aortic dissection during critical care transport.
• This case series supports the expanded role of flight nurses in performing advanced procedures in the pre-hospital setting.
• Further research is warranted to establish definitive guidelines and assess outcomes for this controversial indication.