Pericardiocentesis
Introduction
Pericardiocentesis is the percutaneous aspiration of fluid from the pericardial space to relieve cardiac tamponade or temporise haemodynamic collapse from a large symptomatic effusion.
In emergency care it is a resuscitative procedure: ultrasound‑guided drainage is preferred, but an unsighted (landmark) procedure may be required in extremis when imaging or suitably trained staff are unavailable.
In traumatic tamponade, surgical decompression (resuscitative thoracotomy or pericardial window) is often definitive and is preferred where immediate surgical expertise exists; pericardiocentesis is an alternative when thoracotomy is not possible.
Pathophysiology and indications
Pathophysiology
- The pericardial sac normally contains ~20 mL of serous fluid.
- Tamponade is principally determined by the rate of accumulation: a rapidly developing 100-300 mL can cause tamponade, whereas chronic effusions of larger volume may be tolerated.
- Tamponade physiology: external cardiac compression → impaired ventricular filling → reduced stroke volume and cardiac output → hypotension, collapse or arrest.
Indications for emergency pericardial decompression
- Cardiac arrest or peri‑arrest due to confirmed or strongly suspected pericardial tamponade (urgent decompression required).
- Severe haemodynamic compromise with echocardiographic evidence of tamponade physiology (for example, RA/RV diastolic collapse or a plethoric IVC with minimal respiratory variation).