Unexpected resistance to external cardiac compression may signal pericardial tamponade.
Pericardial tamponade associated with central catheters is often lethal, unless promptly identified. We report our experience with two infants who suffered this complication but were successfully resuscitated. In each case, associated radiographs showed the tip of the central catheter beyond the superior vena cava-right atrium (SVC-RA) junction. Identifying the clinical triad of (1) sudden cardiovascular collapse unresponsive to usual resuscitative measures, (2) thoracic transillumination not suggestive of air leak, and (3) unexpected resistance to external cardiac compression led to the working diagnosis of pericardial tamponade and therapeutic pericardiocentesis. Prompt recovery followed. Central catheters within the RA seem prone to cause pericardial tamponade.
Schulman
Joseph
J
Department of Pediatrics, Division of Neonatology, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA.
Munshi
Upender K
UK
Eastman
Michelle L
ML
Farina
Matthew
M
D002305:Cardiac Tamponade / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003937:Diagnosis, Differential; D006336:Heart Massage; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D020519:Pericardiocentesis; D017211:Treatment Failure