Ultrasound Guided Pericardiocentesis of Cardiac Tamponade

Abstract

A 62-year-old male was brought to the emergency department by prehospital personnel complaining of left-sided weakness and altered mental status after being found on the floor at home. Minutes after arrival, the patient went into cardiac arrest and was noted to have pulseless electrical activity on the cardiac monitor. A bedside cardiac ultrasound was performed and demonstrated minimal cardiac activity in the setting of a large pericardial effusion consistent with cardiac tamponade (Video Clip S1, available as supporting information in the online version of this paper). An 18-gauge 3.5-inch needle was attached to a 60-mL syringe and was advanced between the xiphoid process and left costal margin at 45°, directed toward the left shoulder (Figure 1). With ultrasound guidance, the needle was visualized piercing the left lobe of the liver and entering into the pericardial space (Video Clips S2 and S3, available as supporting information in the online version of this paper), and 60 mL of bright red blood was withdrawn, resulting in improved cardiac contractility. While the patient appeared to respond to the pericardiocentesis, he never had a return of spontaneous circulation. The final images are notable for blood in the pericardium becoming hyperechoic consistent with clotted blood (Video Clip S4, available as supporting information in the online version of this paper). Autopsy confirmed cardiac tamponade secondary to aortic dissection 1.8 cm distal to the aortic valve. Needle is seen (arrow) entering pericardial space. Video Clip S1. Subxiphoid pericardial effusion. Video Clip S2. Needle entering pericardial space. Video Clip S3. Needle tip entering pericardial space. Video Clip S4. Clotted blood and needle tip. Please note: Wiley Periodicals Inc. are not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing material) should be directed to the corresponding author for the article. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.