Complication rates in real-time ultrasound-guided vs static echocardiography-guided pericardiocentesis: a cohort study

TL;DR

This study compares complication rates of two pericardiocentesis techniques and finds both are similarly safe, with real-time ultrasound showing potential benefits.

Contribution

The study evaluates the safety of real-time ultrasound-guided pericardiocentesis compared to the traditional static echocardiography-guided method.

Findings

Real-time in-plane US-guided pericardiocentesis had a 97% success rate compared to 93% for static echo-guided procedures.

Only one major complication occurred with the real-time technique versus four with the static approach.

Total complication rates were not significantly different between the two techniques.

Abstract

Static echocardiography-guided pericardiocentesis, the current standard of care, uses a phased-array probe to locate the largest fluid pocket, marking the safest entry site and needle trajectory. Nevertheless, real-time needle visualization throughout the procedure would potentially increase success and decrease complications. The aim of this study was to assess the complication rates of the real-time in-plane ultrasound-guided technique compared to the traditional static echocardiography-guided pericardiocentesis.

All adult patients who underwent pericardiocentesis in a tertiary care hospital from January 2011 to June 2024 were identified. The incidence of total complications of the real-time, in-plane, US-guided pericardiocentesis versus the static echocardiography-guided technique was compared using a regression model with overlap weighting, based on propensity scores, to adjust for confounding factors.

A total of 220 pericardiocentesis were identified, 91 with real-time, in-plane US-guided technique and 129 with a static echo-guided approach. The overall rate of total complications was 5.5%, with no significant difference between both techniques (IRR 1.06 [95% CI 0.98 to 1.16, p = 0.163]). Only one major complication was reported with the in-plane technique (pulmonary edema) compared to four major complications in the echo-assisted approach (three cardiac injuries and one injury to thoracic vessels), all of which required emergency surgery. The success rate was higher in the real-time in-plane US-guided procedures (97%) compared to the static echo-guided approach (93%).

In this single-center retrospective cohort study, real-time in-plane, US-guided pericardiocentesis technique was safe, and the rate of total complications was not significantly different from a static echo-guided approach. The low rate of major complications and high success rate underscores the potential use of this technique in emergency situations by well-trained physicians. Future studies are warranted to thoroughly assess the potential benefits of the real-time approach.

The online version contains supplementary material available at 10.1186/s44156-025-00071-6.

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