Cardiac tamponade

Introduction

Traumatic cardiac tamponade is most commonly caused from penetrating cardiac injury however may develop with blunt chest trauma.

As the pericardial sac fills with blood, the heart’s ability to pump is compromised with a subsequent drop in cardiac output. The patient will become progressively more shocked eventually leading to cardiac arrest.

Clinical signs

• hypotension
• raised JVP*
• muffed heart sounds*

*can be difficult to elicit these signs reliably in a trauma patient

Ultrasound (eFAST) is the most sensitive diagnostic modality and should be performed as part of the primary survey in shocked patients with suspected tamponade

Management

Urgent thoracotomy is required for patients with traumatic cardiac tamponade

Ideally this should take place in the operating room, however if a patient is periarrest or in cardiac arrest, an ED thoracotomy needs to be considered

Needle pericardiocentesis may provide brief decompression of tamponade (provided the blood has not clotted), however this is a temporising measure only.

Disposition – interhospital transfer guidelines