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Management of pericardial tamponade 

Management of pericardial tamponade
Chapter:
Management of pericardial tamponade
Author(s):

Santanu Biswas

and John J. Frank

DOI:
10.1093/med/9780199600830.003.0167
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date: 18 February 2020

Cardiac tamponade is an emergency, and definitive therapy is fluid removal by pericardiocentesis. In certain conditions, fluid removal is still the optimal choice, but a conservative approach using haemodialysis may be employed. Factors that influence the management strategy include evaluating the cause, providing haemodynamic support, and choosing the technique. Fluid resuscitation to maintain venous pressure and circulation may be beneficial up to a point, after which, tamponade may be aggravated. While inotropes have theoretical benefit, studies involving humans are few. Fluid removal strategies are broadly grouped into percutaneous and surgical methods. In most cases, the percutaneous approach is favoured. However, surgery is typically the first choice in blunt trauma or in proximal aortic dissection. While the safety of percutaneous methods is well established, imaging guidance is needed to avoid common complications associated with a blind technique. The proper management strategy should also minimize effusion recurrence, common methods to do so include placement of a drainage catheter, infusion of a sclerosing agent, and a balloon pericardiotomy procedure. Surgical methods for removal of pericardial fluid include the creation pericardial window, insertion of a pericardioperitoneal shunt, and pericardiectomy. The creation of a pericardial window and pericardioperitoneal shunt are safe, but pericardiectomy is associated with increased morbidity. After fluid removal has been completed, the patient should be placed in a unit that is both familiar with the signs of tamponade and has the capacity to quickly treat a significant effusion if it recurs.

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