Hemodynamic Effects of Volume Expansion in Patients With Cardiac Tamponade

Abstract

Background— Volume expansion has been proposed as an alternative treatment for cardiac tamponade; however, the scientific evidence for this recommendation is very poor. Methods and Results— Forty-nine unselected patients (23 males; age 55±16 years) with large pericardial effusion and hemodynamic tamponade underwent fluid overload with intravenous administration of 500 mL of normal saline over 10 minutes. Cardiac index and intrapericardial, left ventricular end-diastolic, right atrial, and right ventricular end-diastolic pressures were measured during basal state (tamponade), after fluid overload, and after pericardiocentesis. Twenty-eight patients (57%) had physical signs of tamponade, and 10 (20%) were hypotensive. Size of pericardial effusion was 31±13 mm. Initial mean arterial pressure was 88±21 mm Hg, and cardiac index was 2.46±0.80 L · min −1 · m −2 . Intrapericardial pressure was 8.31±5.98 mm Hg. Volume expansion caused a significant increase in mean arterial pressure (from 88±21 to 94±23 mm Hg, P =0.003) and cardiac index (from 2.46±0.80 to 2.64±0.68 L · min −1 · m −2 , P =0.013), as well as in intrapericardial pressure (from 8.31±5.98 to 11.02±6.27 mm Hg, P =0.0001), right atrial pressure (from 9.76±5.91 to 12.82±6.34 mm Hg, P =0.0001), and left ventricular end-diastolic pressure (from 14.21±5.97 to 19.48±6.19 mm Hg, P =0.0001). Cardiac index increased by >10% in 23 patients (47%), remained unchanged in 11 (22%), and decreased in 15 (31%). No patient developed clinical complications. Predictors of this favorable response were systolic blood pressure <100 mm Hg and low cardiac index. Conclusions— Approximately one half of patients with cardiac tamponade develop a significant increase in cardiac output after volume overload. Low systolic blood pressure (<100 mm Hg) at baseline was the simplest clinical finding that was predictive of this favorable response.