LETTER TO THE EDITOR

Traumatic pericardial tamponadetreated by pericardiocentesisDear Editor,

I read with interest a recent case report in the Decem-ber issue of Emergency Medicine Australasia of a trau-matic haemopericardium treated by pericardiocentesis.1

This case was perhaps more a good example of fortuitythan definitive care.

The patient was admitted to the ICU via the ED withcardiac tamponade, a distended abdomen and abnormalvital signs following trauma. The reader is left in thedark as to what assessment, resuscitation or imagingthe patient received in the ED. Was there a trauma callactivated in the ED on arrival? The authors diagnosed apericardial tamponade on echocardiogram in the ICU,following which the ‘surgical team was activated’. Wasthis general surgery or cardiothoracic surgery?

The initial management of the tamponade by percu-taneous drainage is reasonable if no cardiothoracicsurgeon was on site until definitive surgical care. Fol-lowing stabilization, the patient should have beenretrieved to a paediatric trauma centre/paediatric car-diothoracic unit for an emergent thoracotomy if notavailable in that institution.

The authors admit in the discussion section thatthe surgical option would have been preferable. Thereference the authors quote to recent changes to

the Advanced Trauma Life Support guidelines statesthat ‘acute cardiac tamponade due to trauma is bestmanaged by thoracotomy. Pericardiocentesis may beused as a temporizing maneuver when thoracotomy isnot an available option.’2

Pericardial tamponade in blunt trauma should be con-sidered a surgical disease and requires direct open explo-ration of the injury. I commend the authors on successfulresuscitation within their area of clinical expertise andcomfort. However, I believe that the further managementof this patient was suboptimal and should not be consid-ered standard practice. This case also highlights the needfor the development of a paediatric trauma system inSingapore if one is not already in place.

References

1. Choo TL, Wong KY, Chen CK, Tan TH. Successful drainage of atraumatic haemopericardium with pericardiocentesis through anintercostal approach. Emerg. Med. Australas. 2010; 22: 565–7.

2. Kortbeek JB, Al Turki SA, Ali J et al. Advanced Trauma LifeSupport 8th edition, the evidence for change. J. Trauma 2008; 64:1638–50.

Brian Burns

Department of Emergency Medicine, Liverpool Hospital,

Sydney, New South Wales, Australia

doi: 10.1111/j.1742-6723.2011.01429.xEmergency Medicine Australasia (2011) 23, 384

© 2011 The AuthorEMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine