Ultrasound-guided pericardiocentesis: a novel parasternal approach

Adi, Osman; Chuan, Tan Wan; Rahman, Jamalludin Ab; Via, Gabriele; Tavazzi, Guido

doi:10.1097/mej.0000000000000471

Cited by 37 publications

(22 citation statements)

References 22 publications

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“…Osman et al [17] evaluated a novel in-plane parasternal medial-to-lateral approach for pericardiocentesis with a highfrequency probe in patients with cardiac tamponade and reported a 100% success rate without complications. The advantages of this medial-to-lateral approach include better visualization of needle trajectory and adjacent anatomical structures (lungs and thoracic vasculature) with a highfrequency probe which can reduce complications and shorten procedural time.…”

Section: Discussionmentioning

confidence: 99%

What is the ideal approach for emergent pericardiocentesis using point-of-care ultrasound guidance?

Stolz¹,

Situ-LaCasse²,

Acuña³

et al. 2021

World Journal of Emergency Medicine

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BACKGROUND: Traditionally performed using a subxiphoid approach, the increasing use of pointof-care ultrasound in the emergency department has made other approaches (parasternal and apical) for pericardiocentesis viable. The aim of this study is to identify the ideal approach for emergency-physicianperformed ultrasound-guided pericardiocentesis as determined by ultrasound image quality, distance from surface to pericardial fl uid, and likely obstructions or complications. METHODS:A retrospective review of point-of-care cardiac ultrasound examinations was performed in two urban academic emergency departments for the presence of pericardial eff usions. The images were reviewed for technical quality, distance of eff usion from skin surface, and predicted complications.RESULTS: A total of 166 pericardial effusions were identified during the study period. The mean skin-to-pericardial fl uid distance was 5.6 cm (95% confi dence interval [95% CI] 5.2-6.0 cm) for the subxiphoid views, which was signifi cantly greater than that for the parasternal (2.7 cm [95% CI 2.5-2.8 cm], P<0.001) and apical (2.5 cm [95% CI 2.3-2.7 cm], P<0.001) views. The subxiphoid view had the highest predicted complication rate at 79.7% (95% CI 71.5%-86.4%), which was signifi cantly greater than the apical (31.9%; 95% CI 21.4%-44.0%, P<0.001) and parasternal (20.2%; 95% CI 12.8%-29.5%, P<0.001) views. CONCLUSIONS:Our results suggest that complication rates with pericardiocentesis will be lower via the parasternal or apical approach compared to the subxiphoid approach. The distance from skin to fl uid collection is the least in both of these views.

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Section: Discussionmentioning

confidence: 99%

What is the ideal approach for emergent pericardiocentesis using point-of-care ultrasound guidance?

Stolz¹,

Situ-LaCasse²,

Acuña³

et al. 2021

World Journal of Emergency Medicine

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show abstract

“…8 Furthermore, there has been a trend toward real-time continuous guidance both with phased array and high-frequency linear transducers. 11,12 Ultrasound-guided pericardiocentesis has an overall complication rate of 4.7%. 6 Morbidity and mortality from the blind approach are 50% and 6%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic hemodynamically unstable polymicrobial purulent pericarditis: a rare case presentation

2020

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Purulent pericarditis is an extremely rare disease accounting for <1% of pericarditis cases. Purulent pericarditis with hemodyamically unstable tamponade if untreated is fatal. Furthermore, although idiopathic polymicrobial disease is documented, a combination Haemophilus parainfluenzae , Prevotella buccae , and Citrobacter freundii have not been found in the literature by the authors. What follows is a case of a 58‐year‐old male who presented to the emergency department (ED) with these features and underwent emergent bedside pericardiocentesis and a brief review of current pericardiocentesis techniques in the emergency department.

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“…To improve the success and safety of these procedures, US enables us to select needle entry sites with a shorter distance to the pericardium and more accumulated pericardial fluid, including apical and parasternal sites. 30,31 Left ventricular systolic function Focused cardiac US accurately detects left ventricular (LV) systolic dysfunction, LV dilatation, and LV hypertrophy. 27 There has been good evidence that clinicians can be trained in the global assessment or visual estimation of the LV systolic function.…”

Section: Pericardial Effusion/cardiac Tamponadementioning

confidence: 99%

Basic point‐of‐care ultrasound framework based on the airway, breathing, and circulation approach for the initial management of shock and dyspnea

Kameda

Kimura

2020

Acute Medicine & Surgery

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Ultrasound (US) carried out and interpreted by clinicians at the bedside is now called point-of-care US (POCUS). Clinical studies on POCUS have been carried out based on the ideas of "creation", "extraction", and "combination". "Creation" refers to findings for the upper airway and lung being obtained at the bedside. "Extraction" refers to findings suitable for POCUS being extracted from comprehensive US, including echocardiography, abdominal US, and whole-leg US. "Combination" refers to these POCUS applications being combined for the comprehensive assessment of patients with trauma, shock, or dyspnea. Emergency and critical care physicians have many opportunities to encounter trauma or non-trauma patients with shock, dyspnea, or both. Furthermore, the scope of POCUS includes many diseases and injuries that present with both shock and dyspnea. Therefore, we propose a basic POCUS framework based on the systematic airway, breathing, and circulation approach for the initial management of shock and dyspnea in adult patients. In this article, we update and review each application of POCUS and their combination in this framework. Furthermore, we propose the practical usage of the framework based on clinical presentations to improve the management of shock and dyspnea.

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Ultrasound-guided pericardiocentesis: a novel parasternal approach

Abstract: Supplemental Digital Content is available in the text.

Cited by 37 publications

References 22 publications

What is the ideal approach for emergent pericardiocentesis using point-of-care ultrasound guidance?

What is the ideal approach for emergent pericardiocentesis using point-of-care ultrasound guidance?

Idiopathic hemodynamically unstable polymicrobial purulent pericarditis: a rare case presentation

Basic point‐of‐care ultrasound framework based on the airway, breathing, and circulation approach for the initial management of shock and dyspnea

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