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Impact of Controlled Pericardial Drainage on Critical Cardiac Tamponade With Acute Type A Aortic Dissection
Study Questions:
What is the impact of volume controlled pericardial drainage (CPD) until aortic repair on survival of patients with critical cardiac tamponade with acute type A aortic dissection?
Methods:
Between September 2003 and May 2011, 175 patients with acute type A aortic dissection were treated surgically, including 43 (24.6%) who presented with cardiac tamponade on arrival. Eighteen patients, who did not respond to intravenous volume resuscitation, underwent CPD in the emergency department. An 8F pigtail drainage catheter was inserted percutaneously, and drainage volume was controlled by means of several cycles of intermittent drainage to maintain blood pressure at ≈90 mm Hg. After CPD, all of the patients were transferred to the operating room, and immediate aortic repair was performed.
Results:
Systolic blood pressure before CPD was 64.3 ± 8.2 mm Hg and elevated significantly in all of the cases after CPD. Systolic blood pressure after CPD was 94.8 ± 10.5 mm Hg, and increase in systolic pressure was 30.5 ± 11.7 mm Hg. Total volume of aspirated pericardial effusion was 40.1 ± 30.6 ml, and 10 patients required only ≤30 ml aspiration volume. All of the patients underwent aortic repair successfully. In-hospital mortality was 16.7%; however, there was no complications or mortality related to CPD.
Conclusions:
The authors concluded that preoperative pericardial drainage with control of volume is a safe and effective procedure for acute type A aortic dissection complicated by critical cardiac tamponade.
Perspective:
The study suggests that CPD should be considered as one of the treatment options to improve hemodynamic instability in patients with cardiac tamponade that complicates acute type A aortic dissection, particularly if surgery is delayed. An improvement in the patient’s preoperative hemodynamic state may lead to improved outcomes of acute type A aortic dissection with cardiac tamponade. The study findings are consistent with current national guidelines that recommend pericardiocentesis be performed by withdrawing just enough fluid to restore perfusion in patients with hemopericardium and cardiac tamponade who cannot survive until aortic surgery.
Keywords: Resuscitation, Hospital Mortality, Aortic Aneurysm, Thoracic, Cardiovascular Diseases, Blood Pressure, Pericardial Effusion, Hemodynamics, Pericardiocentesis, Cardiac Tamponade
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