Advertisement

Pericardiocentesis in an Ambulance: A Case Report and Lessons Learned

      Highlights

      • Temporizing measures of volume resuscitation and vasopressor therapy are generally used in the prehospital setting for the management of cardiac tamponade.
      • Pericardiocentesis is indicated and can be successfully performed in the prehospital setting for patients with hemodynamic compromise secondary to cardiac tamponade.
      • The addition of positive pressure, whether via intubation, continuous positive airway pressure, or BiLevel positive airway pressure, can aggravate hypotension, especially in preload-dependent conditions, such as cardiac tamponade or hypovolemia.
      • Hypotension, oxygenation, and pH (also known as HOP killers) should be considered before intubation.

      Abstract

      There are few procedures performed in the prehospital setting as intimidating as pericardiocentesis. We report a case in which lifesaving pericardiocentesis was performed in the back of an ambulance after temporizing measures of volume resuscitation and vasopressor therapy failed.
      Fluid accumulation within the pericardial sac can increase pressures around the heart and lead to cardiac tamponade. Helicopter emergency medical service crews may be called to transport patients with cardiac tamponade physiology to definitive care where removal of the pericardial fluid can be achieved. Pericardiocentesis is indicated as an emergency procedure in patients with hemodynamic compromise secondary to cardiac tamponade.
      • Fitch MT
      • Nicks BA
      • Pariyadath M
      • McGinnis HD
      • Manthey DE
      Videos in clinical medicine. Emergency pericardiocentesis.
      Because most HEMS crews do not routinely perform pericardiocentesis because of the rare need or crew scope of practice limitations, the general approach to management in the prehospital setting is volume resuscitation, to overcome decreased preload, and vasopressor support. Here, we report a case in which lifesaving pericardiocentesis was performed in a ground ambulance after temporizing measures of volume resuscitation and vasopressor therapy failed.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Air Medical Journal
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Fitch MT
        • Nicks BA
        • Pariyadath M
        • McGinnis HD
        • Manthey DE
        Videos in clinical medicine. Emergency pericardiocentesis.
        N Engl J Med. 2012; 366: e17
        • Pérez-Casares A
        • Cesar S
        • Brunet-Garcia L
        • Sanchez-de-Toledo J
        Echocardiographic evaluation of pericardial effusion and cardiac tamponade.
        Front Pediatr. 2017; 5: 79
        • Beck CS
        Two cardiac compression triads.
        J Am Med Assoc. 1935; 104: 714-716
        • Aminiahidashti H
        • Shafiee S
        • Zamani Kiasari A
        • Sazgar M
        Applications of end-tidal carbon dioxide (ETCO2) monitoring in emergency department: a narrative review.
        Emerg (Tehran). 2018; 6: e5
        • Sethi M
        • Owyang CG
        • Meyers C
        • Parekh R
        • Shah KH
        • Manini AF
        Choice of resuscitative fluids and mortality in emergency department patients with sepsis.
        Am J Emerg Med. 2018; 36: 625-629
        • Kee VR.
        Hemodynamic pharmacology of intravenous vasopressors.
        Crit Care Nurse. 2003; 23: 79-82
        • Ruffolo Jr, RR
        The pharmacology of dobutamine.
        Am J Med Sci. 1987; 294: 244-248
      1. Weingart S. The HOP Mnemonic and AirwayWorld.com Next Week. EMCrit Blog. June 21, 2012. https://emcrit.org/emcrit/hop-mnemonic/. Accessed March 23, 2019.

        • Shafi S
        • Gentilello L.
        Pre-hospital endotracheal intubation and positive pressure ventilation is associated with hypotension and decreased survival in hypovolemic trauma patients: an analysis of the national trauma data bank.
        J Trauma. 2005; 59 (discussion 1145-1147): 1140-1145
        • Althunayyan SM.
        Shock index as a predictor of post-intubation hypotension and cardiac arrest; a review of the current evidence.
        Bull Emerg Trauma. 2019; 7: 21-27
        • Jones P
        • Dauger S
        • Peters MJ
        Bradycardia during critical care intubation: mechanisms, significance and atropine.
        Arch Dis Child. 2012; 97: 139-144
        • Glassman SH
        • Green MS
        • Brodsky M
        Asystole following reintubation during suspension laryngoscopy.
        Case Rep Anesthesiol. 2012; 2012916306
        • Chetrit M
        • Lipes J
        • Mardigyan V
        A practical approach to pericardiocentesis with periprocedural use of ultrasound training initiative.
        Can J Cardiol. 2018; 34: 1229-1232
        • Pavie A
        • Brucato A
        • Ristić AD
        • et al.
        2015 ESC guidelines for the diagnosis and management of pericardial diseases: the Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS).
        Eur Heart J. 2015; 36: 2921-2964
        • Kumar R
        • Sinha A
        • Lin MJ
        • et al.
        Complications of pericardiocentesis: a clinical synopsis.
        Int J Crit Illn Inj Sci. 2015; 5: 206-212
        • Isselbacher EM
        • Cigarroa JE
        • Eagle KA
        Cardiac tamponade complicating proximal aortic dissection. Is pericardiocentesis harmful?.
        Circulation. 1994; 90: 2375-2378