CHEST Guidelines-A-Spontaneously-Resolving-Pericardial-Effusion-Dur

A-Spontaneously-Resolving-Pericardial-Effusion-Dur

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The document discusses the case of a 62-year-old woman with a pericardial effusion leading to cardiac arrest, published in CHEST 2020. Initially, she had stable pericardial effusion with no signs of cardiac tamponade, but later developed respiratory distress and pulseless electrical activity (PEA) arrest. A point-of-care ultrasound (POCUS) during the code revealed a large effusion with tamponade physiology. While preparing for emergency pericardial drainage, high-quality CPR was performed for 13 minutes, resulting in a return of spontaneous circulation (ROSC). Post-ROSC POCUS and chest radiographs indicated resolution of the pericardial effusion, but a new left-sided pleural effusion was noted.<br /><br />The case suggests that cardiac tamponade caused the arrest, and high-quality CPR might have inadvertently decompressed it. This occurred potentially through pericardial rupture, allowing the effusion to drain into the chest cavity. This incidental decompression is compared to pericardiocentesis, the standard treatment for such tamponade-induced cardiac arrests.<br /><br />The article emphasizes the importance of POCUS in identifying reversible causes of cardiac arrest, such as tamponade, by discerning pseudo-PEA from full cessation of cardiac activity. Despite her stable effusion prior, a progression of her underlying disease likely led to cardiac tamponade.<br /><br />The case represents a rare instance where CPR-associated decompression of tamponade during cardiac arrest was observed via real-time ultrasound, highlighting POCUS's value in critical care for diagnosing and managing cardiac arrest etiologies. It underscores the potentially life-saving role of CPR in decompressing tamponade when coupled with continuous monitoring and highlights the risks of structural injuries from CPR. The narrative serves as educational on the integration of ultrasound in emergency and critical care settings.

Keywords

pericardial effusion

cardiac arrest

POCUS

cardiac tamponade

CPR

ROSC

pericardial rupture

pericardiocentesis

critical care

ultrasound