Pericardiocentesis in trauma: a systematic review.
BACKGROUND
Pericardiocentesis (PCC) had been taught as a mandatory skill in the Advanced Trauma Life Support (ATLS®) course as a bridge to definitive surgical therapy for traumatic pericardial tamponade since its inception in 1978. Immediate thoracotomy for penetrating trauma to the heart and chest has resulted in the decreased use of PCC in trauma. PCC is now offered as an optional skill in the ninth edition of the ATLS®. A review of the literature regarding the use and effectiveness of PCC in traumatic pericardial tamponade in the modern era is necessary to better define its current role in trauma care.


METHODS
Scientific publications from 1970 to 2010 involving PCC after trauma were identified. The Preferred Reporting Items for Systematic reviews and Meta-Analyses was used. Human studies describing acute traumatic tamponade were included. Publications involving nontraumatic or chronic pericardial tamponade from effusions caused by inflammatory, infectious, or neoplastic etiology were excluded. Publications were categorized by level of evidence.


RESULTS
Of the 135 publications identified, 27 were included, composing of 2,094 trauma patients with suspected cardiac tamponade. The reported use of PCC decreased from 45.9% of patients in the period 1970 to 1979 down to 6.4% of patients in the period between 2000 and 2010 (p < 0.05). Reported rates describing the use of PCC as the sole intervention decreased from 13.7% in the period 1970 to 1979 to 2.1% in the period 2000 to 2010 (p < 0.05). Survival analysis after PCC was possible for 380 patients. Overall survival following PCC was 83.4% (n = 317) and 91.8% (n = 145) when used as the sole intervention. In patients who received PCC then thoracotomy, survival rate was 79.5% (n = 178).


CONCLUSIONS
Studies on the use of PCC for trauma are limited and biased toward survivors. The reported survival rate is high. There remains a limited role for PCC in nontrauma centers where definitive surgical management is not immediately available and transport time to a higher level of care facility supports the use of temporary decompression by PCC.


METHODS
Systematic review, level III.
From the Section of Trauma/Critical Care (T.H.L., M.C., M.A.S.), Oregon Health & Science University; Departments of Surgery and Critical Care (J.B.K.), University of Calgary; Department of Surgery (J.-F.O.), Université Laval.
Tim H
TH
Lee
Jean-Francois
JF
Ouellet
Mackenzie
M
Cook
Martin A
MA
Schreiber
John B
JB
Kortbeek
D002305:Cardiac Tamponade / Q000209:etiology / Q000601:surgery; D006801:Humans; D020519:Pericardiocentesis; D013898:Thoracic Injuries / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome