Document Detail

Blind subxiphoid pericardiotomy for cardiac tamponade because of acute hemopericardium.
MedLine Citation:
PMID:  16966991     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Percutaneous catheter drainage (PCD) is not always effective in a case of hemopericardium. Acute occlusion of catheter and cardiac perforation can happen more often. To perform subxiphoid pericardiotomy within a minute for emergency cases, we have done this procedure in a blind method after finger dissection by subxiphoid approach. We report the usefulness of blind subxiphoid pericardiotomy (BSP) based on the results of a prospective control study. METHODS: We designed a study to determine a favorable management for cardiac tamponade resulting from hemopericardium. In an emergency case of cardiac tamponade because of hemopericardium, board certified surgeons should perform BSP and other emergency physicians should perform PCD, with or without local anesthesia. PCD (n = 67) and BSP (n = 16) were performed for patients with cardio-pulmonary arrest (CPA) or near CPA because of cardiac tamponade secondary to trauma (n = 7), acute aortic dissection (n = 65), and cardiac rupture following acute myocardial infarction (n = 11) in our emergency medical center from January 2000 to December 2004. RESULTS: BSP was effective in all cases but PCD was ineffective in five cases because of clotting in pericardium (p = 0.260). No complication was observed in the BSP group but five critical complications and three infeasible drainage complications were observed in the PCD group (p = 0.146). Ten patients (BSP, 4; PCD, 6; p = 0.077) survived after emergency surgery (n = 8) or conservative treatment (n = 2). CONCLUSION: BSP was safe and could be performed quickly in an emergency situation. Percutaneous catheter drainage for hemopericardium could not avoid critical complications because of clotting in pericardium.
Yoshihiko Kurimoto; Mamoru Hase; Satoshi Nara; Naoya Yama; Nobuyoshi Kawaharada; Kiyofumi Morishita; Tetsuya Higami; Yasufumi Asai
Publication Detail:
Type:  Comparative Study; Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  61     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  2006 Sep 
Date Detail:
Created Date:  2006-09-12     Completed Date:  2006-10-18     Revised Date:  2007-07-18    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  582-5     Citation Subset:  AIM; IM    
Department of Traumatology and Critical Care Medicine, Sapporo Medical University, Sapporo, Japan.
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MeSH Terms
Cardiac Tamponade / etiology,  surgery*
Emergency Medical Services / methods*
Heart Arrest / etiology,  therapy
Pericardial Effusion / complications,  surgery*
Pericardiectomy / methods*
Prospective Studies
Treatment Outcome
Xiphoid Bone
Comment In:
J Trauma. 2007 Jan;62(1):264   [PMID:  17215770 ]
J Trauma. 2007 May;62(5):1317; author reply 1317-8   [PMID:  17495752 ]

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