Bedside Pericardiocentesis and Pericardial Drain Placement by Critical Care Physicians After Cardiac Surgery: A Retrospective Analysis.

OBJECTIVE

Our primary objective was to assess the incidence of operating room drainage of postoperative pericardial effusion after cardiac surgery for patients treated at the bedside with ultrasound-guided drainage and to evaluate the safety of this procedure.

DESIGN

Single-center retrospective cohort conducted between January 2018 and December 2023.

SETTING

A 95-bed postoperative cardiothoracic intensive care unit (ICU).

PATIENTS: Adult patients with postoperative pericardial effusion who required pericardiocentesis and pericardial drain placement by cardiothoracic ICU physicians.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN

RESULTS

The primary outcome was the need for operating room drainage after percutaneous drainage. The secondary outcome was a collapsed composite of serious adverse events, including significant site bleeding, cardiac tamponade, cardiac perforation, cardiac ischemia from coronary artery injury, hemothorax, and pneumothorax. Of the 324 patients entered into the analysis, 18 (5.56%; 95% CI 3.06%, 8.05%) required surgical drainage. No serious adverse events, including significant site bleeding, cardiac perforation, hemothorax, or pneumothorax, were observed. Patients who required surgical drainage were more likely to have lower initial drainage volumes (400 mL [250, 500] v 175 mL [93, 525], p = 0.03) and to have tamponade as the indication for drainage (39% v 8%, p < 0.01). The odds of requiring reoperation were higher with tamponade as the indication for drainage (OR 9.61; 95% CI 3.35, 17.6, p < 0.01) and with a shorter time from index surgery to pericardiocentesis (OR 1.04; 95% CI 1.01, 1.07, p < 0.01).

CONCLUSION

In this patient population, pericardiocentesis was safely performed by cardiothoracic ICU physicians at the bedside and was associated with a low rate of subsequent surgical drainage. Bedside drainage of pericardial effusions may reduce the need for reoperation and related patient morbidity. Future studies should further refine the indications for postoperative pericardiocentesis and better identify the predictors of a successful procedure.