The effect of different relieving methods on the outcome of out-of-hospital cardiac arrest patients with nontraumatic hemopericardium in the ED.
OBJECTIVE
This study aimed to assess the impact of different methods of draining nontraumatic hemopericardium on outcome from patients with out-of-hospital cardiac arrest (OHCA), identify independent predictors of return of spontaneous circulation (ROSC), and examine the ineffective rate of decompression based on subxiphoid pericardiotomy (SP) and percutaneous pericardial catheter drainage (PCD).


METHODS
Adult patients with OHCA who presented to the ED between May 1, 2000, and October 30, 2006, with moderate to massive nontraumatic hemopericardium were recruited and stratified into 4 groups according to the relieving methods of hemopericardium. Charts were reviewed for various demographic data, resuscitation records, management, and outcome. Patient outcome was recorded as survival to hospital discharge and ROSC, as primary end points. Effective decompression was recorded as a secondary end point. We compared the outcome between the groups.


RESULTS
A total of 1491 OHCA resuscitation records were prospective collected. There were 23 OHCA patients with moderate to massive nontraumatic hemopericardium. The overall ROSC rate was 39.1% (9/23). There was a clear difference in the ROSC rate between 4 groups (P < .05). The overall rate of survival to hospital discharge was 4.3% (1/23). There was no significant difference in the rate of survival to hospital discharge between the groups. Relieving methods was an independent predictor of ROSC in OHCA patients with nontraumatic hemopericardium (odds ratio, 0.17; 95% confidence interval, 0.4-0.70). There was a significant statistical difference in adequate relief of hemopericardium based on SP and PCD (P < .01).


CONCLUSIONS
The early effective decompression method is associated with an increased rate of ROSC for OHCA patients with nontraumatic hemopericardium. Subxiphoid pericardiotomy has a better effective decompression of hemopericardium than PCD.
Wang
Ruei-Fang
RF
Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan.
Chao
Chun-Chieh
CC
Wang
Tzong-Luen
TL
Chen
Kuo-Chih
KC
Chong
Chee-Fah
CF
Huang
Kuo-Hung
KH
Chen
Chien-Chih
CC
D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D002404:Catheterization; D019299:Decompression, Surgical; D004322:Drainage; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000150:complications / Q000628:therapy*; D010492:Pericardiectomy; D020519:Pericardiocentesis; D016019:Survival Analysis; D016896:Treatment Outcome