Blind subxiphoid pericardiotomy for cardiac tamponade because of acute hemopericardium.
OBJECTIVE
Percutaneous catheter drainage (PCD) is not always effective in a case of hemopericardium. Acute occlusion of catheter and cardiac perforation can happen more often. To perform subxiphoid pericardiotomy within a minute for emergency cases, we have done this procedure in a blind method after finger dissection by subxiphoid approach. We report the usefulness of blind subxiphoid pericardiotomy (BSP) based on the results of a prospective control study.


METHODS
We designed a study to determine a favorable management for cardiac tamponade resulting from hemopericardium. In an emergency case of cardiac tamponade because of hemopericardium, board certified surgeons should perform BSP and other emergency physicians should perform PCD, with or without local anesthesia. PCD (n = 67) and BSP (n = 16) were performed for patients with cardio-pulmonary arrest (CPA) or near CPA because of cardiac tamponade secondary to trauma (n = 7), acute aortic dissection (n = 65), and cardiac rupture following acute myocardial infarction (n = 11) in our emergency medical center from January 2000 to December 2004.


RESULTS
BSP was effective in all cases but PCD was ineffective in five cases because of clotting in pericardium (p = 0.260). No complication was observed in the BSP group but five critical complications and three infeasible drainage complications were observed in the PCD group (p = 0.146). Ten patients (BSP, 4; PCD, 6; p = 0.077) survived after emergency surgery (n = 8) or conservative treatment (n = 2).


CONCLUSIONS
BSP was safe and could be performed quickly in an emergency situation. Percutaneous catheter drainage for hemopericardium could not avoid critical complications because of clotting in pericardium.
Kurimoto
Yoshihiko
Y
Department of Traumatology and Critical Care Medicine, Sapporo Medical University, Sapporo, Japan. kurimoto@sapmed.ac.jp
Hase
Mamoru
M
Nara
Satoshi
S
Yama
Naoya
N
Kawaharada
Nobuyoshi
N
Morishita
Kiyofumi
K
Higami
Tetsuya
T
Asai
Yasufumi
Y
D002305:Cardiac Tamponade / Q000209:etiology / Q000601:surgery*; D004632:Emergency Medical Services / Q000379:methods*; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy; D006801:Humans; D010490:Pericardial Effusion / Q000150:complications / Q000601:surgery*; D010492:Pericardiectomy / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome; D014989:Xiphoid Bone