Pericardiocentesis in contemporary practice.
Inglis R., King AJ., Gleave M., Bradlow W., Adlam D.
OBJECTIVE: Pericardiocentesis is a life-saving procedure associated with a small, but significant, risk of major complication. An apical or subcostal approach may be used, although the relative complication rates are not reported. In modern practice, an increasing proportion of pericardial effusions occur as a result of catheter-laboratory related complications. This study examines current practice and analyzes the complications of pericardial drainage according to the route of approach. DESIGN: Historical cohort study. SETTING: Four Oxfordshire hospitals, including the John Radcliffe Hospital, a tertiary referral center. PATIENTS: Local databases were searched to identify percutaneous pericardiocenteses carried out between November 2002 and October 2009. RESULTS: A total of 188 pericardiocenteses were performed in 163 patients. Malignancy (55; 33.7%) and catheter-based cardiac procedures (45; 23.9%) were the most common causes of pericardial effusions requiring drainage. 50.0% of all pericardiocenteses were performed in patients who had received anticoagulant or antiplatelet agents the same day. This rose to 93.7% in patients whose effusions occurred as a complication of a catheter-based procedure. Nine complications occurred during the study period, giving an overall complication rate of 4.8%. Six of the complications occurred via the subcostal route and all 4 complications requiring surgery occurred via the subcostal route. CONCLUSION: The numbers of iatrogenic pericardial effusions occurring as a complication of catheter-based procedures mean that a significant proportion of pericardiocenteses are being performed in anticoagulated patients. This may alter the risk profile. Although complication rates were low for both routes, all major complications requiring surgery occurred via the subcostal approach. These data suggest an apical approach may be preferable where practical.