Echo-Guided Emergency Pericardiocentesis

Echo-guided emergency pericardiocentesis is the percutaneous drainage of fluid from the pericardial space under continuous ultrasound visualization. It is indicated when pericardial effusion produces hemodynamic compromise (cardiac tamponade) or when large effusion threatens deterioration before formal surgical drainage can be arranged.

Real-time echocardiography identifies the optimal puncture site, depth and trajectory, typically using a subcostal, apical or parasternal approach depending on effusion location. Subcostal access has historically been classical, but apical and parasternal approaches reduce risk of liver and gastric injury and are increasingly preferred when ultrasound guidance is available.

Complications include pneumothorax, ventricular puncture, coronary artery injury and arrhythmias. After initial decompression, a pigtail catheter may be left in place for continued drainage and underlying etiologic evaluation including malignancy, uremia, infection or autoimmune disease.