Rottländer D, Saal M, Degen H, Haude M
Department of Cardiology, Rheinlandklinikum Neuss, Neuss, Germany.
Department of Cardiology, Krankenhaus Porz am Rhein, Cologne, Germany.
Neth Heart J. 2023 Feb;31(2):61-67. doi: 10.1007/s12471-022-01701-y. Epub 2022 Jun 1.
Cardiac tamponade is a rare but life-threatening complication of cardiac interventions. Despite prompt pericardiocentesis, clinical management can be challenging and sometimes haemodynamic stabilisation is difficult to achieve. Intra-pericardial thrombin injection after pericardiocentesis promotes haemostasis and acts as a sealing agent, as previously described for left ventricular free-wall rupture. We aimed to evaluate intra-pericardial thrombin injection as a bailout strategy for pericardial tamponade following percutaneous cardiac interventions.
In a 5-year single-centre retrospective analysis we identified 31 patients with cardiac tamponade due to percutaneous intracardiac procedures. Intra-pericardial thrombin injection as a bailout strategy was administered in 5 of 31 patients (16.1%).
Patients receiving intra-pericardial thrombin were in a more critical state when thrombin was applied, as demonstrated by a higher rate of resuscitation (40% versus 26.9%) and a trend toward a prolonged stay in the intensive care unit (177.6 ± 84.0 vs 98.0 ± 31.4 h). None of the patients with pericardial tamponades treated with intra-pericardial thrombin needed cardiothoracic surgery. Mortality after 30 days was lower with intra-pericardial thrombin injection than with standard treatment (0% vs 15.4%). We observed no complications using intra-pericardial thrombin.
Intra-pericardial thrombin injection could be considered as a bailout strategy for patients with iatrogenic pericardial tamponade due to percutaneous procedures. We recommend further evaluation of this technique in the clinical management of refractory pericardial tamponade.
心脏压塞是心脏介入治疗中一种罕见但危及生命的并发症。尽管及时进行了心包穿刺术，但临床管理仍具有挑战性，有时难以实现血流动力学稳定。心包穿刺术后心包内注射凝血酶可促进止血，并作为一种封闭剂，如先前针对左心室游离壁破裂所描述的那样。我们旨在评估心包内注射凝血酶作为经皮心脏介入治疗后心脏压塞的一种补救策略。
在一项为期5年的单中心回顾性分析中，我们确定了31例因经皮心内手术导致心脏压塞的患者。31例患者中有5例（16.1%）采用心包内注射凝血酶作为补救策略。
应用凝血酶时，接受心包内注射凝血酶的患者病情更为危急，复苏率更高（40%对26.9%），且在重症监护病房的停留时间有延长趋势（177.6±84.0小时对98.0±31.4小时）。接受心包内注射凝血酶治疗的心包压塞患者均无需进行心胸外科手术。心包内注射凝血酶后30天的死亡率低于标准治疗（0%对15.4%）。我们观察到心包内注射凝血酶无并发症发生。
心包内注射凝血酶可被视为因经皮手术导致医源性心包压塞患者的一种补救策略。我们建议在难治性心包压塞的临床管理中对该技术进行进一步评估。
