Percutaneous drainage of large pericardial effusion in intensive care unit: Safety and outcome

Introduction Large pericardial effusion (LPE) management can be challenging in intensive care unit. Data regarding the prognosis of LPE undergoing percutaneous pericardiocentesis are scarce. Purposes To assess the safety of percutaneous pericardiocentesis. To evaluate the outcome of LPE managed with percutaneous pericardiocentesis. Methods Patients who underwent percutaneous drainage of an LPE from November 2011 to October 2019 in the intensive care unit of a tertiary care center were included. Procedure-related complications, overall survival and effusion recurrence rate and were analyzed. Results One hundred and seventy nine percutaneous pericardiocentesis were performed in One hundred and seventy one patients. Procedure was successful in 97.8% of the cases. A subxiphoid approach was used in 81.6%, an apical approach in 17.3% and a right parasternal approach in 1.1% of the cases. There were 5 complications (2.8%) that all occurred with a subxiphoid approach. There were no procedure-related deaths. No predictive factors for success or complication of the procedure were found. Most common etiologies were neoplasia (43.3%) and iatrogenicity (14.0%). Most frequent malignancies were lung cancer (54.1%), lymphoma (9.5%) and leukemia (6.8%). Cancer was previously unknown for 14.9% of patients with malignancy-related effusions. Presence of malignant cells in the pericardial fluid was an independent factor of 30-days and 1-year mortality (P = 0.007 and P = 0.005, respectively) in the multivariate analysis (adjustment on active neoplasia, lung cancer and LPE recurrence). A total of 10.5% of patients had LPE recurrence. 94.4% of recurrences occurred in the first 100 days. No predictive factors for recurrence were found ( Fig. 1 ). Conclusion Percutaneous pericardiocentesis is efficient for treating patients with LPE. Apical approach is safe in our experience. Presence of malignant cells in pericardial fluid analysis is strongly associated with mortality. Follow-up should be more frequent during the first 3 months after drainage.