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. 2021 Feb 5:32:100722.
doi: 10.1016/j.ijcha.2021.100722. eCollection 2021 Feb.

Treatment of acute cardiac tamponade: A retrospective analysis of classical intermittent versus continuous pericardial drainage

Christopher Stremmel  1   2 , Clemens Scherer  1   2 , Enzo Lüsebrink  1   2 , Danny Kupka  1   2 , Teresa Schmid  1   2 , Thomas Stocker  1   2 , Antonia Kellnar  1   2 , Jan Kleeberger  1   2 , Moritz F Sinner  1   2 , Tobias Petzold  1   2 , Julinda Mehilli  2   3 , Daniel Braun  1   2 , Mathias Orban  1   2 , Jörg Hausleiter  1   2 , Steffen Massberg  1   2 , Martin Orban  1   2
Affiliations

Treatment of acute cardiac tamponade: A retrospective analysis of classical intermittent versus continuous pericardial drainage

Christopher Stremmel et al. Int J Cardiol Heart Vasc. .

Abstract

Background: Acute cardiac tamponade is a life-threatening pathology in modern cardiology as catheter-based interventions become increasingly relevant. Pericardiocentesis is usually the primary treatment of choice. However, protocols for handling of draining pigtail catheters are very variable due to limit data and require further investigation.

Methods: We retrospectively analyzed 52 patients with acute cardiac tamponade requiring immediate pericardiocentesis from January 2017 to August 2020. Patients were treated with a classical approach of intermittent manual aspiration or continuous pericardial drainage using a redon drainage system.

Results: Mean age of patients was 74 years in both groups. Most common causes for cardiac tamponade were percutaneous coronary interventions in about 50% and transaortic valve implantations in 25% of all cases. 28 patients were treated with classic intermittent drainage from 2017 to 2020. 24 patients were treated with continuous drainage from December 2018-2020. Compared to classical intermittent drainage treatment, continuous drainage was associated with a lower rate of a surgical intervention or cardiac re-tamponade and a lower mortality at 5 days (HR 0.2, 95% CI 0.1-0.9, log-rank p = 0.03). Despite a longer total drainage time under continuous suction, drainage volumes were comparable in both groups.

Conclusion: Acute cardiac tamponade can be efficiently treated by pericardiocentesis with subsequent continuous negative pressure drainage via a pigtail catheter. Our retrospective analysis shows a significantly lower mortality, a decreased rate of interventions and lower rates of cardiac re-tamponade without any relevant side effects when compared to classical intermittent manual drainage. These findings require further investigations in larger, randomized trials.

Keywords: Drainage; Intervention; Pericardial effusion; Pericardiocentesis; Tamponade; cont., continiuous; int., intermittent.

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Conflict of interest statement

Mathias Orban and Daniel Braun received speaker honoraria from Abbott Vascular, outside the submitted work. Jörg Hausleiter received speaker honoraria and research support from Abbott Vascular and Edwards Lifesciences, outside the submitted work. Martin Orban received speaker honoraria from Abbott Medical, AstraZeneca, Abiomed, Bayer vital, BIOTRONIK, Bristol-Myers Squibb, CytoSorbents, Daiichi Sankyo Deutschland, Edwards Lifesciences Services, Sedana Medical, outside the submitted work. The other authors declare no conflict of interests.

Figures

Fig. 1
Fig. 1
Procedural success: (A) Time-dependent choice of intermittent or continuous drainage therapy. Procedural success parameters including pericardial clotting (B), re-tamponade (C), conversion to open-heart surgery (D), drainage duration (E) and total bleeding volume (F).
Fig. 2
Fig. 2
Survival rates at 5 and 30 days: Depicted are Kaplan-Meier curves for survival on day 5 (A) and 30 (B) after acute cardiac tamponade and subsequent drainage with either intermittent or continuous suction.
See this image and copyright information in PMC

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