M. Katsura1, C. Ambrose1, M.J. Martin1, K. Inaba1, K. Matsushima1 1University Of Southern California, Trauma And Acute Care Surgery, Los Angeles, CA, USA
Introduction:
According to the latest edition of the Advanced Trauma Life Support (ATLS), pericardiocentesis is one of the therapeutic options for pericardial tamponade from cardiac injuries. However, significant knowledge gaps exist regarding recent practice changes and indications for pericardiocentesis. This study aimed to describe contemporary practice patterns and nationwide trends in the use of emergency pericardiocentesis in trauma.
Methods:
We conducted a retrospective descriptive study using the National Trauma Data Bank from 2011 to 2022. We included patients who underwent pericardiocentesis within 48 hours of hospital arrival and prior to operative interventions if performed. In addition to clinical and injury characteristics, we captured pericardiocentesis timing and the proportion of patients found to have cardiac injuries. The Cochran–Armitage test was used for trend analysis.
Results:
A total of 1,036 patients were included. Of those, 59% sustained blunt trauma and 25% presented with hypotension. Pericardiocentesis was usually performed immediately after arrival (median: 38 minutes) in penetrating trauma patients, whereas approximately 30% of blunt trauma patients underwent pericardiocentesis more than 4 hours after arrival (Figure C). Following pericardiocentesis, 79% of penetrating trauma patients and 34% of blunt trauma patients were taken to the operating room. During the study period, there was a significant downward linear trend in the proportion of patients with cardiac injuries in penetrating trauma (range: 55% to 27%; P for trend < 0.001), while no significant trend was observed in blunt trauma (range: 15% to 9%; P for trend = 0.623) (Figure A, B).
Conclusion:
This study observed different practice patterns in the use of emergent pericardiocentesis between penetrating and blunt trauma patients. Our results indicate that emergent pericardiocentesis is performed sooner after arrival in penetrating trauma patients. Despite this, the overall incidence of cardiac injury remains low among all patients undergoing this procedure. These findings suggest that pericardiocentesis may be more commonly utilized as a diagnostic adjunct than as a therapeutic tool.