Effectiveness and outcomes of 2 therapeutic interventions for cardiac tamponade

Zgheib, Hady; Wakil, Cynthia; Shayya, Sami; Bachir, Rana; Sayed, Mazen El

doi:10.1097/md.0000000000021290

Cited by 5 publications

(6 citation statements)

References 28 publications

(35 reference statements)

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“…Existing data comparing mortality after PC and SD are mixed. In studies examining the management of cardiac tamponade, both Allen et al and Zgheib et al found an approximate 4–5% increase in mortality following PC compared to SD [ 8 , 17 ]. In contrast, several other studies found no difference in mortality between the two treatment strategies [ 7 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the current era of value-based medicine, there is a growing emphasis on delivering optimal care while minimizing healthcare-related costs. A recent study by Zgheib et al found cardiac tamponade patients treated with SD to have lower mortality rates but longer length of stay and higher healthcare expenses [ 17 ]. Our study expands upon these findings in a larger, more contemporary cohort and includes long-term readmission outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Pericardiocentesis or surgical drainage: A national comparison of clinical outcomes and resource use

et al. 2022

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Background While institutional series have sought to define the optimal strategy for drainage of pericardial effusions, large-scale comparisons remain lacking. Using a nationally representative sample, the present study examined clinical and financial outcomes following pericardiocentesis (PC) and surgical drainage (SD) in patients admitted for pericardial effusion and tamponade. Methods Adults undergoing PC or SD within 2 days of admission for non-surgically related pericardial effusion or tamponade were identified in the 2016–2019 Nationwide Readmissions Database. Multivariable logistic and linear models were developed to evaluate the association between intervention type and outcomes. The primary outcome of interest was mortality while secondary endpoints included reintervention, periprocedural complications, hospital length of stay (LOS), hospitalization costs and 30-day non-elective readmission. Results Of an estimated 44,637 records meeting inclusion criteria, 28,862 (64.7%) underwent PC while the remainder underwent SD for initial management of pericardial effusion or tamponade. PC was associated with significantly increased odds of in-hospital mortality, reintervention and 30-day readmission relative to SD. PC was also associated with greater odds of cardiac complications but lower odds of infection, respiratory failure and blood transfusions compared to SD. Although PC was associated with shorter index hospital length of stay and costs, the two strategies yielded similar 30-day cumulative costs. Conclusion Management of pericardial effusion with PC is associated with greater odds of mortality, reintervention and 30-day readmission but similar 30-day cumulative costs compared to SD. In the setting of adequate hospital capability and operator expertise, SD is a reasonable initial treatment strategy for pericardial effusion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pericardiocentesis or surgical drainage: A national comparison of clinical outcomes and resource use

et al. 2022

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“…In a recent study based on US Nationwide Emergency Department Sample database, tamponade patients treated with surgical pericardiotomy had lower mortality rates but longer length of stay and higher health care expenses. 24 There is need for defining easily reproducible CT criteria to standardize reporting of PeEff on CT similar to echocardiography. Standardized objective and subjective CT criteria can be used to more effectively compare the findings with echocardiography, and document disease resolution or progression.…”

Section: Discussionmentioning

confidence: 99%

“…Early diagnosis of cardiac tamponade is essential as these patients may require urgent percutaneous pericardiocentesis or surgical pericardiotomy. In a recent study based on US Nationwide Emergency Department Sample database, tamponade patients treated with surgical pericardiotomy had lower mortality rates but longer length of stay and higher health care expenses 24 …”

Section: Discussionmentioning

confidence: 99%

Standardized Criteria for Identification of Cardiac Tamponade on Non–Electrocardiogram-gated Computed Tomography

Bothwell¹,

Ling

Ambrosini³

et al. 2022

Journal of Thoracic Imaging

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Purpose: To identify imaging parameters that can help in the diagnosis of cardiac tamponade on non–electrocardiogram (ECG)-gated computed tomography (CT) of the chest. Materials and Methods: Retrospective analysis of 64 patients who had undergone CT and echocardiography for evaluation of cardiac tamponade. Of 64 patients, 34 were diagnosed with tamponade and underwent pericardiocentesis for further diagnosis and treatment. CT measurements obtained were: pericardial effusion (PeEff) pocket size in 6 locations (anterior, posterior, superior, inferior, right, and left lateral), pericardial thickening, diameters of the coronary sinus, upper superior vena cava, lower superior vena cava, and inferior vena cava. In addition, cardiac chamber sizes were measured. Subjective assessment of coronary sinus compression, pericardial enhancement, and pericardial thickening were also recorded. Results: Measurement of the sum of the right lateral and left lateral PeEff thickness resulted in 91.2% sensitivity and 86.7% specificity for cardiac tamponade with a threshold of 30 mm (receiver-operating characteristic area under the curve=0.94 [0.84 to 0.98], P<0.0001). Using the combination of inferior PeEff >16 mm, sum of right lateral and left lateral PeEff>30 mm, and presence of pericardial thickening resulted in 56% sensitivity and 100% specificity and positive predictive value for the determination of cardiac tamponade. Conclusions: Our study suggests that CT measurements related to PeEff size and thickness aid in the diagnosis of cardiac tamponade.

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“…However, for those patients in whom this procedure is indicated, there are two methods of pericardial drainage: pericardiocentesis (PCC) and surgical pericardiotomy (SP). Previous studies have shown that the survival rates of PCC and SP are comparable [5][6][7][8] ; the survival rate of SP is higher 9 in patients with endogenous disease, but these patients cannot be considered to have trauma because of differences in the underlying disease and nature of the fluid reservoir. There are a few small studies on cases of blunt traumatic cardiac tamponade [10][11][12][13][14] and the evidence is insufficient.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effectiveness of pericardiocentesis and surgical pericardiotomy in the prognosis of patients with blunt traumatic cardiac tamponade: a multicenter study using the Japan Trauma Data Bank

Omoto

Tanaka

Fukuda

et al. 2022

Acute Medicine & Surgery

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Aim To compare the prognostic impact of pericardiocentesis (PCC) and surgical pericardiotomy (SP) in blunt traumatic pericardial tamponade. Methods Among 361,706 trauma patients registered in the Japan Trauma Data Bank from January 2004 to December 2018, we included those with blunt traumatic cardiac tamponade who underwent PCC and/or SP. We excluded patients with penetrating trauma, age younger than 15 years, Injury Severity Score (ISS) equal to 75, blood pressure 0 mmHg at the time of admission, head Abbreviated Injury Scale (AIS) score 5 or more, and those with missing data for outcomes. To examine the effect of SP, patients were divided into a PCC group and an SP‐only group. Missing values of age, sex, systolic blood pressure, respiratory rate, pulse rate, time from emergency call to hospital arrival, head AIS, chest AIS, abdomen/pelvis AIS, Glasgow Coma Scale score, and ISS were estimated using multiple imputation. In‐hospital mortality was analyzed using multivariable analysis, and we undertook a survival analysis. Results We analyzed 305 patients, 150 (49.2%) in the PCC group and 155 (50.8%) in the SP‐only group. The in‐hospital mortality rate was 40.7% in the PCC group and 76.8% in the SP‐only group. Multivariable analysis after multiple imputation showed an odds ratio of SP for in‐hospital mortality 5.34 (95% confidence interval, 2.80–10.18; P < 0.01) compared with PCC. Using the Kaplan–Meier method, SP showed a significant risk of mortality (hazard ratio 2.16; 95% confidence interval, 1.58–2.95; P < 0.01). Conclusions In patients with blunt traumatic cardiac tamponade, SP was associated with poor prognosis.

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Effectiveness and outcomes of 2 therapeutic interventions for cardiac tamponade

Abstract: Supplemental Digital Content is available in the text

Cited by 5 publications

References 28 publications

Pericardiocentesis or surgical drainage: A national comparison of clinical outcomes and resource use

Pericardiocentesis or surgical drainage: A national comparison of clinical outcomes and resource use

Standardized Criteria for Identification of Cardiac Tamponade on Non–Electrocardiogram-gated Computed Tomography

Comparison of the effectiveness of pericardiocentesis and surgical pericardiotomy in the prognosis of patients with blunt traumatic cardiac tamponade: a multicenter study using the Japan Trauma Data Bank

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