Timing of pericardiocentesis and clinical outcomes: Is earlier pericardiocentesis better?

Onyinyechi F Eke; Lauren Selame; Jamie Gullikson; Hao Deng; Sayon Dutta; Hamid Shokoohi

doi:10.1016/j.ajem.2022.01.062

Timing of pericardiocentesis and clinical outcomes: Is earlier pericardiocentesis better?

Am J Emerg Med. 2022 Apr:54:202-207. doi: 10.1016/j.ajem.2022.01.062. Epub 2022 Feb 3.

Authors

Onyinyechi F Eke¹, Lauren Selame², Jamie Gullikson³, Hao Deng⁴, Sayon Dutta⁵, Hamid Shokoohi⁶

Affiliations

¹ Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: oeke@mgh.harvard.edu.
² Department of Emergency Medicine, Brigham and Women's Hospital, MA 02115, USA. Electronic address: lselame@bwh.harvard.edu.
³ Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: jgullikson@mgh.harvard.edu.
⁴ Department of Anesthesia, Massachusetts General Hospital, MA 02114, USA. Electronic address: hdeng1@mgh.harvard.edu.
⁵ Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: sdutta1@partners.org.
⁶ Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: hshokoohi@mgh.harvard.edu.

PMID: 35176659
DOI: 10.1016/j.ajem.2022.01.062

Abstract

Background: Pericardial tamponade is critical clinical diagnosis that requires prompt management and intervention. However, it is unknown if early pericardiocentesis is associated with better or worse patient outcomes.

Methods: A retrospective chart review was performed on all emergency department patients from two large academic hospitals with pericardial tamponade who underwent pericardiocentesis during the index hospitalization between March 2015-August 2020. We included only those who underwent pericardiocentesis within 24 h of their ED presentations. Subjects were stratified based on the time of pericardiocentesis, with early intervention defined as pericardiocentesis within <12 h and late intervention as those 12-24 h. Clinical outcomes of interest were; procedural complications, intensive care unit (ICU) admission, hospital length of stay (LOS), in hospital mortality, 30-day and first year survival. The effect of early vs. late intervention on survival was analyzed using log-rank tests for univariate analyses, Cox proportional hazard models for multivariable analyses and propensity matching.

Results: 205 patients with a mean age of 60 years, and 53.2% female were included. The median door-to-pericardiocentesis time for the early and late group were 5.0 h [interquartile range (IQR) 3.3-7.4] and 18.5 h (IQR 15.9-21.0), respectively. Transthoracic echocardiography (TTE) in patients in the early group more frequently demonstrated right atrial collapse (78.7% vs 58.6%) and exaggerated mitral inflow velocity variances (84.8% vs 70.0%). Early pericardiocentesis was associated with a hazard ratio of 2.909 (95% CI: 0.926-9.137, p = 0.067) for 30-day survival and 3.124 (95% CI, 1.648-5.924, p < 0.001) for 1-year survival.

Conclusion: Early pericardiocentesis was associated with decreased 1-year survival. Future prospective analysis adjusting for patients' complexities is required.

Keywords: Pericardial tamponade; Pericardiocentesis; Point-of-care ultrasound (POCUS); Transthoracic echocardiography (TTE).

MeSH terms

Cardiac Tamponade* / diagnosis
Cardiac Tamponade* / surgery
Female
Humans
Male
Middle Aged
Pericardial Effusion* / complications
Pericardial Effusion* / surgery
Pericardiocentesis / adverse effects
Retrospective Studies
Treatment Outcome