Emergency Pericardiocentesis in Children

Abstract

Cardiac tamponade is a life-threatening condition characterized by compression of the heart due to pericardial accumulation of different types of fluid and requires prompt diagnosis and immediate therapeutic intervention. Echocardiography is the most useful imaging technique to diagnose the cardiac tamponade and to evaluate the size, location, and hemodynamic impact of the pericardial effusion. Emergency pericardiocentesis is the procedure used for the aspiration of the fluid from the pericardial space in patients with significant pericardial effusion which determines hemodynamic compromise (cardiac tamponade). Emergency pericardiocentesis in children is performed under local anesthesia and is echocardiographic-guided. The first step of echocardiographic-guided pericardiocentesis is to assess the dimension and distribution of the pericardial fluid and the optimal trajectory of the needle in order to efficiently evacuate the pericardial fluid. The transducer is situated 3–5 cm from the parasternal border and the trajectory of the needle is established by the angle of the transducer. The needle is positioned between the xiphoid process and the left costal cartilages and is advanced, while a continuous aspiration is performed. It is important to avoid the neighboring vital organs (heart, liver, lung, internal mammary artery, and the intercostal vascular bundle). Complications which can occur are as follows: dysrhythmias, puncture of coronary artery or mammary artery, hemothorax, pneumothorax, pneumopericardium, and hepatic injury.