Virginia Zarama, Carlos E Vesga, John Balanta-Silva, Mario M Barbosa, Jaime A Quintero, Ana Clarete, Paula A Vesga-Reyes, Juan Carlos Silva Godinez
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引用次数: 0
Abstract
Background: 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.
Methods: 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.
Results: 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%).
Conclusions: 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.
背景：静态超声心动图引导下的心包穿刺是目前的标准护理方法，使用相控阵探针定位最大的液体袋，标记最安全的进入部位和针头轨迹。然而，在整个手术过程中，实时针头可视化可能会增加成功率并减少并发症。本研究的目的是评估实时平面内超声引导技术与传统静态超声心动图引导的心包穿刺技术的并发症发生率。方法：选取2011年1月至2024年6月在某三级医院行心包穿刺术的所有成年患者。采用基于倾向评分的重叠加权回归模型，比较实时、平面内、us引导的心包穿刺与静态超声心动图引导技术的总并发症发生率，以调整混杂因素。结果：共鉴定了220例心包穿刺术，其中91例采用实时平面内超声引导技术，129例采用静态超声引导方法。总并发症的总发生率为5.5%，两种技术之间无显著差异（IRR 1.06 [95% CI 0.98 ~ 1.16, p = 0.163]）。与回声辅助入路的4个主要并发症（3个心脏损伤和1个胸血管损伤）相比，平面内技术仅报告了1个主要并发症（肺水肿），所有这些并发症都需要紧急手术。与静态超声引导入路（93%）相比，实时平面内超声引导入路的成功率更高（97%）。结论：在这项单中心回顾性队列研究中，实时平面内超声引导心包穿刺技术是安全的，总并发症发生率与静态超声引导入路无显著差异。主要并发症的低发生率和高成功率强调了训练有素的医生在紧急情况下使用该技术的潜力。未来的研究有必要彻底评估实时方法的潜在好处。
期刊介绍：
Echo Research and Practice aims to be the premier international journal for physicians, sonographers, nurses and other allied health professionals practising echocardiography and other cardiac imaging modalities. This open-access journal publishes quality clinical and basic research, reviews, videos, education materials and selected high-interest case reports and videos across all echocardiography modalities and disciplines, including paediatrics, anaesthetics, general practice, acute medicine and intensive care. Multi-modality studies primarily featuring the use of cardiac ultrasound in clinical practice, in association with Cardiac Computed Tomography, Cardiovascular Magnetic Resonance or Nuclear Cardiology are of interest. Topics include, but are not limited to: 2D echocardiography 3D echocardiography Comparative imaging techniques – CCT, CMR and Nuclear Cardiology Congenital heart disease, including foetal echocardiography Contrast echocardiography Critical care echocardiography Deformation imaging Doppler echocardiography Interventional echocardiography Intracardiac echocardiography Intraoperative echocardiography Prosthetic valves Stress echocardiography Technical innovations Transoesophageal echocardiography Valve disease.
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