Triage strategy for urgent management of cardiac tamponade: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases

Abstract

Prompt recognition of cardiac tamponade is critical since the underlying haemodynamic disorder can lead to death if not resolved by percutaneous or surgical drainage of the pericardium. Cardiac tamponade is a condition caused by the compression of the heart due to slow or rapid accumulation of fluid (exudate), pus, blood, clots, or gas within the pericardial space resulting in impaired diastolic filling and cardiac output due to increased intrapericardial pressure.1–3 Pericardial diseases of any aetiology may cause cardiac tamponade, but with highly variable incidence reflecting the local epidemiological background ( Table 1 ).3–6 However, all interventional procedures (i.e. percutaneous coronary intervention, transcatheter aortic valve implantation, pacemaker/implantable cardioverter defibrillator implantation, arrhythmias ablation, endomyocardial biopsy) are emerging causes of cardiac tamponade.7 Although rare, cardiac tamponade may also occur in pregnancy and in post-partum.8,9 Thus cardiologists should be aware of this possibility including specific contraindications for pregnancy (i.e. avoid the use of colchicine and X-ray exposure using echo-guided procedure).13,14 View this table: Table 1 Causes of pericardial disease and precipitating factors causing cardiac tamponade Management of cardiac tamponade can be challenging because of the lack of the validated criteria for the risk stratification that should guide clinicians in the decision-making process: (i) which patients need immediate drainage of the pericardial effusion? (ii) Is echocardiography sufficient for guidance of pericardiocentesis or should patient be taken to the cardiac catheterization laboratory? (iii) Who should be transferred to specialized/tertiary institution or surgical service? (iv) What type of medical support is necessary during transportation? Current European guidelines published in 2004 by the European Society of Cardiology3 do not cover these issues and no additional guidelines are available from major medical and Cardiology societies. Therefore, the aim of this position statement is to provide updated, evidence-based recommendations, when available, for …