• Youichi Yanagawa, Kei Jitsuiki, Soichiro Ota, Ken-Ichi Muramatsu, Yoshihiro Kushida, Hiroki Nagasawa, Ikuto Takeuchi, Hiromichi Ohsaka, Kazuhio Omori, and Kouhei Ishikawa.
• Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan. Electronic address: yyanaga@juntendo.ac.jp.
• Am J Emerg Med. 2021 Dec 1; 50: 636-639.

BackgroundThe outcomes of patients with cardiac arrest induced by non-traumatic hemorrhagic cardiac tamponade are poor.PurposeWe retrospectively investigated the significance of medical intervention with pericardiocentesis and/or pericardiotomy for non-traumatic hemorrhagic cardiac tamponade.MethodsFrom January 2013 to April 2021, we retrospectively reviewed the medical charts of all patients with cardiac arrest in a prehospital setting or emergency room due to cardiac tamponade confirmed by an ultrasound examination with or without an invasive procedure (pericardiocentesis and/or pericardiotomy) and computed tomography findings, including those obtained at autopsy imaging. The subjects were divided into two groups: the Intervention (+) group, which included subjects who underwent pericardiocentesis or pericardiotomy, and the Intervention (-) group, which included subjects who did not undergo pericardiocentesis or pericardiotomy. Variables were then compared between the two groups.ResultsThere were 68 patients with non-traumatic cardiac tamponade. All three survival cases had witnessed collapse, and the initial rhythm was pulseless electrical activity (PEA).There were no statistically significant differences in the sex, age, means of transportation, bystander chest compression, electric shock, or adrenalineor FDP levels between the two groups.However, the number with witnessed collapse, PEA, rupture of the heart;the ratio of obtaining return of spontaneous circulation; and the survival ratio were significantly greater in the Intervention (+) group than in the Intervention (-) group.ConclusionBased on the results of preliminary study, we hypothesized that invasive medical intervention for patients with cardiac arrest induced by non-traumatic hemorrhagic cardiac tamponade might be useful for obtaining return of spontaneous circulation and a survival outcome, especially for patients with witnessed collapse with PEA as the initial rhythm.Copyright © 2021 Elsevier Inc. All rights reserved.

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