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World Journal of Emergency Medicine ›› 2021, Vol. 12 ›› Issue (3): 169-173.doi: 10.5847/wjem.j.1920-8642.2021.03.001

• Original Articles •     Next Articles

What is the ideal approach for emergent pericardiocentesis using point-of-care ultrasound guidance?

Lori Stolz1, Elaine Situ-LaCasse2, Josie Acuña2, Matthew Thompson3, Nicolaus Hawbaker4, Josephine Valenzuela5, Uwe Stolz1, Srikar Adhikari6()   

  1. 1 Department of Emergency Medicine, the University of Cincinnati, Cincinnati 45267, USA
    2 Department of Emergency Medicine, Banner University Medical Center-Tucson, Tucson 85719, USA
    3 Baptist Medical Center Jacksonville, Jacksonville 32207, USA
    4 Flagstaff Medical Center, Flagstaff 86001, USA
    5 Northwest Medical Center, Tucson 85741, USA
    6 Department of Emergency Medicine, the University of Arizona, Tucson 85724, USA
  • Received:2019-12-06 Accepted:2020-08-20 Online:2021-06-01 Published:2021-05-31
  • Contact: Srikar Adhikari


BACKGROUND: Traditionally performed using a subxiphoid approach, the increasing use of point-of-care ultrasound in the emergency department has made other approaches (parasternal and apical) for pericardiocentesis viable. The aim of this study is to identify the ideal approach for emergency-physician-performed ultrasound-guided pericardiocentesis as determined by ultrasound image quality, distance from surface to pericardial fluid, and likely obstructions or complications.

METHODS: A retrospective review of point-of-care cardiac ultrasound examinations was performed in two urban academic emergency departments for the presence of pericardial effusions. The images were reviewed for technical quality, distance of effusion from skin surface, and predicted complications.

RESULTS: A total of 166 pericardial effusions were identified during the study period. The mean skin-to-pericardial fluid distance was 5.6 cm (95% confidence interval [95% CI] 5.2-6.0 cm) for the subxiphoid views, which was significantly greater than that for the parasternal (2.7 cm [95% CI 2.5-2.8 cm], P<0.001) and apical (2.5 cm [95% CI 2.3-2.7 cm], P<0.001) views. The subxiphoid view had the highest predicted complication rate at 79.7% (95% CI 71.5%-86.4%), which was significantly greater than the apical (31.9%; 95% CI 21.4%-44.0%, P<0.001) and parasternal (20.2%; 95% CI 12.8%-29.5%, P<0.001) views.

CONCLUSIONS: Our results suggest that complication rates with pericardiocentesis will be lower via the parasternal or apical approach compared to the subxiphoid approach. The distance from skin to fluid collection is the least in both of these views.

Key words: Pericardiocentesis, Pericardial effusion, Point-of-care ultrasound, Emergency department, Subxiphoid, Parasternal, Apical