Use of an autologous blood recovery system during emergency pericardiocentesis in the electrophysiology laboratory.
BACKGROUND
Emergency pericardiocentesis during electrophysiology procedures is often associated with significant aspiration of pericardial blood, requiring transfusion. We sought to assess the feasibility of urgent use of an autologous blood recovery system in the electrophysiology laboratory to autotransfuse blood aspirated from the pericardium.


RESULTS
We retrospectively analyzed Mayo Clinic electrophysiology records for patients who had ablation procedure-related pericardial effusions requiring emergency pericardial drainage during an 8-month period. An autologous blood recovery system was used during pericardiocentesis to separate and clean packed red blood cells from the pericardial aspirate. These cells were returned acutely to the patient intravenously. The procedural safety, aspirated and autotransfused volumes, and efficacy of this approach were evaluated. During the study period, nine patients underwent pericardial drainage with autotransfusion using a cell-salvage instrument during electrophysiology procedures. The mean aspirated volume was 1,078 mL, with a mean autotransfused volume of 390 mL. For four patients, all with aspirated volumes of 1,100 mL or less, autotransfusion alone was sufficient to maintain hemodynamic stability and avoid allogeneic transfusion. One patient required surgical intervention because of ongoing pericardial bleeding. The ablation procedure was completed after aspiration in two patients. No procedural complications related to the use of the cell-salvage system occurred.


CONCLUSIONS
Autologous blood recovery during pericardiocentesis is safe, convenient, and feasible. With early use it may decrease or eliminate the need for allogeneic blood transfusion and, in selected cases, may permit completion of the ablation procedure.
Venkatachalam
K L
KL
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
Fanning
Lisa J
LJ
Willis
Elaine A
EA
Beinborn
Douglas S
DS
Bradley
David J
DJ
Cha
Yong-Mei
YM
Shen
Win-Kuang
WK
Asirvatham
Samuel J
SJ
Sinak
Lawrence J
LJ
Packer
Douglas L
DL
Munger
Thomas M
TM
Santrach
Paula J
PJ
Friedman
Paul A
PA
D000328:Adult; D000368:Aged; D001781:Blood Component Removal / Q000295:instrumentation*; D001804:Blood Transfusion, Autologous / Q000295:instrumentation* / Q000379:methods; D002305:Cardiac Tamponade / Q000209:etiology* / Q000517:prevention & control*; D017115:Catheter Ablation / Q000009:adverse effects*; D004632:Emergency Medical Services / Q000379:methods; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000209:etiology* / Q000628:therapy*; D020519:Pericardiocentesis / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome