Ultrasound-guided pericardiocentesis

a novel parasternal approach

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

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: The aim of this study was to evaluate a novel pericardiocentesis technique using an in-plane parasternal medial-to-lateral approach with the use of a high-frequency probe in patients with cardiac tamponade.

BACKGROUND: Echocardiography is pivotal in the diagnosis of pericardial effusion and tamponade physiology. Ultrasound guidance for pericardiocentesis is currently considered the standard of care. Several approaches have been described recently, which differ mainly on the site of puncture (subxiphoid, apical, or parasternal). Although they share the use of low-frequency probes, there is absence of complete control of needle trajectory and real-time needle visualization. An in-plane and real-time technique has only been described anecdotally.

METHODS AND RESULTS: A retrospective analysis of 11 patients (63% men, mean age: 37.7±21.2 years) presenting with cardiac tamponade admitted to the tertiary-care emergency department and treated with parasternal medial-to-lateral in-plane pericardiocentesis was carried out. The underlying causes of cardiac tamponade were different among the population. All the pericardiocentesis were successfully performed in the emergency department, without complications, relieving the hemodynamic instability. The mean time taken to perform the eight-step procedure was 309±76.4 s, with no procedure-related complications.

CONCLUSION: The parasternal medial-to-lateral in-plane pericardiocentesis is a new technique theoretically free of complications and it enables real-time monitoring of needle trajectory. For the first time, a pericardiocentesis approach with a medial-to-lateral needle trajectory and real-time, in-plane, needle visualization was performed in a tamponade patient population.

Original languageEnglish
Pages (from-to)322-327
Number of pages6
JournalEuropean Journal of Emergency Medicine
Volume25
Issue number5
DOIs
Publication statusPublished - Oct 2018

Fingerprint

Pericardiocentesis
Cardiac Tamponade
Needles
Hospital Emergency Service
Pericardial Effusion
Tertiary Healthcare
Standard of Care
Punctures
Population
Echocardiography
Hemodynamics

Keywords

  • Adolescent
  • Adult
  • Cardiac Tamponade/diagnostic imaging
  • Cohort Studies
  • Emergency Service, Hospital
  • Female
  • Humans
  • Image Enhancement/methods
  • Malaysia
  • Male
  • Middle Aged
  • Patient Positioning/methods
  • Patient Safety
  • Pericardiocentesis/instrumentation
  • Prognosis
  • Retrospective Studies
  • Sternum
  • Treatment Outcome
  • Ultrasonography, Doppler/methods
  • Young Adult

Cite this

Ultrasound-guided pericardiocentesis : a novel parasternal approach. / Osman, Adi; Wan Chuan, Tan; Ab Rahman, Jamalludin; Via, Gabriele; Tavazzi, Guido.

In: European Journal of Emergency Medicine, Vol. 25, No. 5, 10.2018, p. 322-327.

Research output: Contribution to journalArticle

Osman, Adi ; Wan Chuan, Tan ; Ab Rahman, Jamalludin ; Via, Gabriele ; Tavazzi, Guido. / Ultrasound-guided pericardiocentesis : a novel parasternal approach. In: European Journal of Emergency Medicine. 2018 ; Vol. 25, No. 5. pp. 322-327.
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abstract = "OBJECTIVE: The aim of this study was to evaluate a novel pericardiocentesis technique using an in-plane parasternal medial-to-lateral approach with the use of a high-frequency probe in patients with cardiac tamponade.BACKGROUND: Echocardiography is pivotal in the diagnosis of pericardial effusion and tamponade physiology. Ultrasound guidance for pericardiocentesis is currently considered the standard of care. Several approaches have been described recently, which differ mainly on the site of puncture (subxiphoid, apical, or parasternal). Although they share the use of low-frequency probes, there is absence of complete control of needle trajectory and real-time needle visualization. An in-plane and real-time technique has only been described anecdotally.METHODS AND RESULTS: A retrospective analysis of 11 patients (63{\%} men, mean age: 37.7±21.2 years) presenting with cardiac tamponade admitted to the tertiary-care emergency department and treated with parasternal medial-to-lateral in-plane pericardiocentesis was carried out. The underlying causes of cardiac tamponade were different among the population. All the pericardiocentesis were successfully performed in the emergency department, without complications, relieving the hemodynamic instability. The mean time taken to perform the eight-step procedure was 309±76.4 s, with no procedure-related complications.CONCLUSION: The parasternal medial-to-lateral in-plane pericardiocentesis is a new technique theoretically free of complications and it enables real-time monitoring of needle trajectory. For the first time, a pericardiocentesis approach with a medial-to-lateral needle trajectory and real-time, in-plane, needle visualization was performed in a tamponade patient population.",
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T1 - Ultrasound-guided pericardiocentesis

T2 - a novel parasternal approach

AU - Osman, Adi

AU - Wan Chuan, Tan

AU - Ab Rahman, Jamalludin

AU - Via, Gabriele

AU - Tavazzi, Guido

PY - 2018/10

Y1 - 2018/10

N2 - OBJECTIVE: The aim of this study was to evaluate a novel pericardiocentesis technique using an in-plane parasternal medial-to-lateral approach with the use of a high-frequency probe in patients with cardiac tamponade.BACKGROUND: Echocardiography is pivotal in the diagnosis of pericardial effusion and tamponade physiology. Ultrasound guidance for pericardiocentesis is currently considered the standard of care. Several approaches have been described recently, which differ mainly on the site of puncture (subxiphoid, apical, or parasternal). Although they share the use of low-frequency probes, there is absence of complete control of needle trajectory and real-time needle visualization. An in-plane and real-time technique has only been described anecdotally.METHODS AND RESULTS: A retrospective analysis of 11 patients (63% men, mean age: 37.7±21.2 years) presenting with cardiac tamponade admitted to the tertiary-care emergency department and treated with parasternal medial-to-lateral in-plane pericardiocentesis was carried out. The underlying causes of cardiac tamponade were different among the population. All the pericardiocentesis were successfully performed in the emergency department, without complications, relieving the hemodynamic instability. The mean time taken to perform the eight-step procedure was 309±76.4 s, with no procedure-related complications.CONCLUSION: The parasternal medial-to-lateral in-plane pericardiocentesis is a new technique theoretically free of complications and it enables real-time monitoring of needle trajectory. For the first time, a pericardiocentesis approach with a medial-to-lateral needle trajectory and real-time, in-plane, needle visualization was performed in a tamponade patient population.

AB - OBJECTIVE: The aim of this study was to evaluate a novel pericardiocentesis technique using an in-plane parasternal medial-to-lateral approach with the use of a high-frequency probe in patients with cardiac tamponade.BACKGROUND: Echocardiography is pivotal in the diagnosis of pericardial effusion and tamponade physiology. Ultrasound guidance for pericardiocentesis is currently considered the standard of care. Several approaches have been described recently, which differ mainly on the site of puncture (subxiphoid, apical, or parasternal). Although they share the use of low-frequency probes, there is absence of complete control of needle trajectory and real-time needle visualization. An in-plane and real-time technique has only been described anecdotally.METHODS AND RESULTS: A retrospective analysis of 11 patients (63% men, mean age: 37.7±21.2 years) presenting with cardiac tamponade admitted to the tertiary-care emergency department and treated with parasternal medial-to-lateral in-plane pericardiocentesis was carried out. The underlying causes of cardiac tamponade were different among the population. All the pericardiocentesis were successfully performed in the emergency department, without complications, relieving the hemodynamic instability. The mean time taken to perform the eight-step procedure was 309±76.4 s, with no procedure-related complications.CONCLUSION: The parasternal medial-to-lateral in-plane pericardiocentesis is a new technique theoretically free of complications and it enables real-time monitoring of needle trajectory. For the first time, a pericardiocentesis approach with a medial-to-lateral needle trajectory and real-time, in-plane, needle visualization was performed in a tamponade patient population.

KW - Adolescent

KW - Adult

KW - Cardiac Tamponade/diagnostic imaging

KW - Cohort Studies

KW - Emergency Service, Hospital

KW - Female

KW - Humans

KW - Image Enhancement/methods

KW - Malaysia

KW - Male

KW - Middle Aged

KW - Patient Positioning/methods

KW - Patient Safety

KW - Pericardiocentesis/instrumentation

KW - Prognosis

KW - Retrospective Studies

KW - Sternum

KW - Treatment Outcome

KW - Ultrasonography, Doppler/methods

KW - Young Adult

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DO - 10.1097/MEJ.0000000000000471

M3 - Article

VL - 25

SP - 322

EP - 327

JO - European Journal of Emergency Medicine

JF - European Journal of Emergency Medicine

SN - 0969-9546

IS - 5

ER -