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Ultrasound-guided pericardiocentesis: a novel parasternal approach

OBJECTIVE: The aim of this study was to evaluate a novel pericardiocentesis technique using an in-plane parasternal medial-to-lateral approach with the use of a high-frequency probe in patients with cardiac tamponade. BACKGROUND: Echocardiography is pivotal in the diagnosis of pericardial effusion a...

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Autores principales: Osman, Adi, Wan Chuan, Tan, Ab Rahman, Jamalludin, Via, Gabriele, Tavazzi, Guido
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133212/
https://www.ncbi.nlm.nih.gov/pubmed/28509710
http://dx.doi.org/10.1097/MEJ.0000000000000471
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author Osman, Adi
Wan Chuan, Tan
Ab Rahman, Jamalludin
Via, Gabriele
Tavazzi, Guido
author_facet Osman, Adi
Wan Chuan, Tan
Ab Rahman, Jamalludin
Via, Gabriele
Tavazzi, Guido
author_sort Osman, Adi
collection PubMed
description OBJECTIVE: The aim of this study was to evaluate a novel pericardiocentesis technique using an in-plane parasternal medial-to-lateral approach with the use of a high-frequency probe in patients with cardiac tamponade. BACKGROUND: Echocardiography is pivotal in the diagnosis of pericardial effusion and tamponade physiology. Ultrasound guidance for pericardiocentesis is currently considered the standard of care. Several approaches have been described recently, which differ mainly on the site of puncture (subxiphoid, apical, or parasternal). Although they share the use of low-frequency probes, there is absence of complete control of needle trajectory and real-time needle visualization. An in-plane and real-time technique has only been described anecdotally. METHODS AND RESULTS: A retrospective analysis of 11 patients (63% men, mean age: 37.7±21.2 years) presenting with cardiac tamponade admitted to the tertiary-care emergency department and treated with parasternal medial-to-lateral in-plane pericardiocentesis was carried out. The underlying causes of cardiac tamponade were different among the population. All the pericardiocentesis were successfully performed in the emergency department, without complications, relieving the hemodynamic instability. The mean time taken to perform the eight-step procedure was 309±76.4 s, with no procedure-related complications. CONCLUSION: The parasternal medial-to-lateral in-plane pericardiocentesis is a new technique theoretically free of complications and it enables real-time monitoring of needle trajectory. For the first time, a pericardiocentesis approach with a medial-to-lateral needle trajectory and real-time, in-plane, needle visualization was performed in a tamponade patient population.
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spelling pubmed-61332122018-09-20 Ultrasound-guided pericardiocentesis: a novel parasternal approach Osman, Adi Wan Chuan, Tan Ab Rahman, Jamalludin Via, Gabriele Tavazzi, Guido Eur J Emerg Med Original Articles OBJECTIVE: The aim of this study was to evaluate a novel pericardiocentesis technique using an in-plane parasternal medial-to-lateral approach with the use of a high-frequency probe in patients with cardiac tamponade. BACKGROUND: Echocardiography is pivotal in the diagnosis of pericardial effusion and tamponade physiology. Ultrasound guidance for pericardiocentesis is currently considered the standard of care. Several approaches have been described recently, which differ mainly on the site of puncture (subxiphoid, apical, or parasternal). Although they share the use of low-frequency probes, there is absence of complete control of needle trajectory and real-time needle visualization. An in-plane and real-time technique has only been described anecdotally. METHODS AND RESULTS: A retrospective analysis of 11 patients (63% men, mean age: 37.7±21.2 years) presenting with cardiac tamponade admitted to the tertiary-care emergency department and treated with parasternal medial-to-lateral in-plane pericardiocentesis was carried out. The underlying causes of cardiac tamponade were different among the population. All the pericardiocentesis were successfully performed in the emergency department, without complications, relieving the hemodynamic instability. The mean time taken to perform the eight-step procedure was 309±76.4 s, with no procedure-related complications. CONCLUSION: The parasternal medial-to-lateral in-plane pericardiocentesis is a new technique theoretically free of complications and it enables real-time monitoring of needle trajectory. For the first time, a pericardiocentesis approach with a medial-to-lateral needle trajectory and real-time, in-plane, needle visualization was performed in a tamponade patient population. Lippincott Williams & Wilkins 2018-10 2017-05-15 /pmc/articles/PMC6133212/ /pubmed/28509710 http://dx.doi.org/10.1097/MEJ.0000000000000471 Text en Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Original Articles
Osman, Adi
Wan Chuan, Tan
Ab Rahman, Jamalludin
Via, Gabriele
Tavazzi, Guido
Ultrasound-guided pericardiocentesis: a novel parasternal approach
title Ultrasound-guided pericardiocentesis: a novel parasternal approach
title_full Ultrasound-guided pericardiocentesis: a novel parasternal approach
title_fullStr Ultrasound-guided pericardiocentesis: a novel parasternal approach
title_full_unstemmed Ultrasound-guided pericardiocentesis: a novel parasternal approach
title_short Ultrasound-guided pericardiocentesis: a novel parasternal approach
title_sort ultrasound-guided pericardiocentesis: a novel parasternal approach
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133212/
https://www.ncbi.nlm.nih.gov/pubmed/28509710
http://dx.doi.org/10.1097/MEJ.0000000000000471
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