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

作　　者：Lori Stolz Elaine Situ-LaCasse Josie Acuña Matthew Thompson Nicolaus Hawbaker Josephine Valenzuela Uwe Stolz Srikar Adhikari 

机构地区：[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

出　　处：《World Journal of Emergency Medicine》2021年第3期169-173,共5页世界急诊医学杂志（英文）

摘　　要：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 fl uid,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 eff usions.The images were reviewed for technical quality,distance of eff usion from skin surface,and predicted complications.RESULTS:A total of 166 pericardial effusions were identified during the study period.The mean skin-to-pericardial fl uid distance was 5.6 cm(95%confi dence interval[95%CI]5.2-6.0 cm)for the subxiphoid views,which was signifi cantly 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 signifi cantly 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 fl uid collection is the least in both of these views.

关 键 词：PERICARDIOCENTESIS Pericardial effusion Point-of-care ultrasound Emergency department Subxiphoid Parasternal APICAL 

分 类 号：R542.1[医药卫生—心血管疾病]