title: Blind subxiphoid pericardiotomy to relieve critical acute hemopericardium: a final report.
abstract: OBJECTIVE
  Percutaneous catheter drainage (PCD) has been considered a standard method of relieving acute cardiac tamponade. Although conventional subxiphoid pericardiotomy is useful even for clotted hemopericardium, it has been believed to be unsuitable for emergency treatment because it is a time-consuming procedure. We report our modified pericardiotomy technique that can be used for emergency management.
  
  
  METHODS
  We designed a prospective observational study to evaluate blind subxiphoid pericardiotomy (BSP) for critical cardiac tamponade due to hemopericardium. Emergency patients (n = 148) with acute hemopericardium secondary to trauma (n = 12), acute aortic disease (n = 122), or cardiac rupture following acute myocardial infarction (n = 14) were the subjects. Early results were compared between the BSP group (n = 53) and the PCD group (n = 95).
  
  
  RESULTS
  BSP was effective at relieving cardiac tamponade in all 53 cases, but PCD was ineffective in 12 cases (12.6 %, p = 0.008). Procedure-related complication rates of BSP and PCD were 0 and 16.8 %, respectively (p = 0.002). Survival rates for the BSP and PCD groups were 18.9 and 6.3 %, respectively (p = 0.018). Since 2005, when we discarded the restriction that only board-certified surgeons should perform BSP, acute care physicians (including trainees) have performed BSP for 22 patients without procedure-related complications.
  
  
  CONCLUSIONS
  BSP was safe and effective for cardiac tamponade due to acute hemopericardium. Critical complications during PCD for hemopericardium could not be avoided in some cases because of clots in the pericardium.
authors.affiliation: Department of Traumatology and Acute Care Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan. kurimoto@sapmed.ac.jp.
authors.forename: Y
authors.initials: Y
authors.lastname: Kurimoto
authors.affiliation: Department of Traumatology and Acute Care Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Maekawa
authors.affiliation: Department of Traumatology and Acute Care Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Tanno
authors.affiliation: Department of Traumatology and Acute Care Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Mori
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University, Sapporo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Koyanagi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University, Sapporo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University, Sapporo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Kawaharada
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University, Sapporo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Watanabe
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University, Sapporo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Higami
authors.affiliation: Department of Traumatology and Acute Care Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Asai
keywords: Cardiac tamponade; Hemopericardium; Pericardiocentesis; Pericardiotomy
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