Timing of pericardiocentesis and clinical outcomes: Is earlier pericardiocentesis better?

• Published in: The American journal of emergency medicine Vol. 54; pp. 202 - 207
• Main Authors: Eke, Onyinyechi F., Selame, Lauren, Gullikson, Jamie, Deng, Hao, Dutta, Sayon, Shokoohi, Hamid
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2022; Elsevier Limited
• Subjects: Blood pressure; Cardiac Tamponade - diagnosis; Cardiac Tamponade - surgery; Cardiology; Clinical outcomes; Echocardiography; Electronic health records; Emergency; Emergency medical care; Female; Hospitals; Humans; Intervention; Male; Medical records; Middle Aged; Mortality; Patients; Pericardial Effusion - complications; Pericardial Effusion - surgery; Pericardial tamponade; Pericardiocentesis; Pericardiocentesis - adverse effects; Point-of-care ultrasound (POCUS); Retrospective Studies; Survival; Tamponade; Transthoracic echocardiography (TTE); Treatment Outcome; Vital signs; Point-of-care ultrasound (POCUS); Pericardial tamponade; Pericardiocentesis; Transthoracic echocardiography (TTE); Echocardiography (ECHO)
• ISSN: 0735-6757; 1532-8171; 1532-8171
• DOI: 10.1016/j.ajem.2022.01.062

Pericardial tamponade is critical clinical diagnosis that requires prompt management and intervention. However, it is unknown if early pericardiocentesis is associated with better or worse patient outcomes. A retrospective chart review was performed on all emergency department patients from two large academic hospitals with pericardial tamponade who underwent pericardiocentesis during the index hospitalization between March 2015–August 2020. We included only those who underwent pericardiocentesis within 24 h of their ED presentations. Subjects were stratified based on the time of pericardiocentesis, with early intervention defined as pericardiocentesis within <12 h and late intervention as those 12–24 h. Clinical outcomes of interest were; procedural complications, intensive care unit (ICU) admission, hospital length of stay (LOS), in hospital mortality, 30-day and first year survival. The effect of early vs. late intervention on survival was analyzed using log-rank tests for univariate analyses, Cox proportional hazard models for multivariable analyses and propensity matching. 205 patients with a mean age of 60 years, and 53.2% female were included. The median door-to-pericardiocentesis time for the early and late group were 5.0 h [interquartile range (IQR) 3.3–7.4] and 18.5 h (IQR 15.9–21.0), respectively. Transthoracic echocardiography (TTE) in patients in the early group more frequently demonstrated right atrial collapse (78.7% vs 58.6%) and exaggerated mitral inflow velocity variances (84.8% vs 70.0%). Early pericardiocentesis was associated with a hazard ratio of 2.909 (95% CI: 0.926–9.137, p = 0.067) for 30-day survival and 3.124 (95% CI, 1.648–5.924, p < 0.001) for 1-year survival. Early pericardiocentesis was associated with decreased 1-year survival. Future prospective analysis adjusting for patients' complexities is required.