Non-surgical management in hemodynamically unstable blunt traumatic pericardial effusion: A feasible option for treatment

Abstract

Introduction: Little is known about the outcomes of deliberate non-surgical management for hemodynamically unstable patients with blunt traumatic pericardial effusion. We evaluated the efficacy of management with pericardiocentesis or subxiphoid pericardial window in hemodynamically unstable patients who reach the hospital alive with blunt traumatic pericardial effusion.

Methods: We conducted a review of a consecutive series of patients with pericardial effusion following blunt trauma who arrived at Fukui Prefectural Hospital between January 1, 2009 and December 31, 2017. All patients with traumatic pericardial effusion were included, irrespective of the type of blunt trauma.

Results: Eleven patients were identified arrived to the Emergency Department with a pericardial effusion after blunt trauma. Of the eleven patients, five patients had cardiopulmonary arrest on arrival and none survived. Of the other six patients who reached the hospital alive, five were hemodynamically unstable and clinically diagnosed with cardiac tamponade. One patient was hemodynamically stable and managed conservatively without pericardiocentesis or pericardial window. Otherwise, two patients were managed with pericardiocentesis alone. One patient was managed with pericardial window alone. One was managed with both pericardiocentesis and pericardial window. The remaining patient underwent median sternotomy because of unsuccessful pericardial drainage tube insertion. All six patients who reached the hospital alive survived. Five patients did not require surgical repair.

Conclusion: The results of the present study suggested that non-surgical management of hemodynamically unstable patients who reach hospital alive with blunt pericardial effusion may be a feasible option for treatment.

Keywords: Blunt trauma; Hemodynamic instability; Pericardial effusion; Pericardial window.