Recent trends of pericardiocentesis in pediatric population

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BACKGROUND: Pericardiocentesis serves both diagnostic and life-saving purposes across a range of clinical scenarios. Despite its importance, there remain limited data regarding the effectiveness and safety of pericardiocentesis in the clinical setting, particularly in the pediatric population. This study aimed to investigate the recent trends in pericardiocentesis among pediatric patients in a tertiary referral center and to determine the factors associated with clinical outcomes, including recurrence requiring repeat intervention. METHODS: We retrospectively reviewed clinical data of patients who underwent pericardiocentesis for clinically significant pericardial effusion (PE) from January 2003 to December 2023. RESULTS: A total of 68 pericardiocentesis procedures were performed for 58 pediatric patients (32 males and 26 females). The median age of patients was 6.4 years at the time of pericardiocentesis (interquartile range [IQR]: 2.3–12.4 years). Post-pericardiotomy syndrome, malignancy-related PE, and iatrogenic effusions associated with invasive procedures accounted for over 70% of all cases requiring pericardiocentesis. The majority of the patients had large-volume PE. The subxiphoid approach was used in most cases (77.9%). Three major complications (4.4%) were observed, including one requiring surgical intervention (pneumothorax with pneumopericardium). The other two were cases of pericardial decompression-related cardiac failure that were managed conservatively. Repeat intervention was required in seven patients within six months of the initial procedure. The absence of indwelling drainage catheter placement was associated with a significantly increased risk of recurrence requiring repetitive intervention (OR 115.0, p < 0.001, Fisher’s exact test). CONCLUSIONS: In this cohort, most pericardiocentesis procedures were performed for post-pericardiotomy syndrome, malignancy-related PE and iatrogenic complications associated with invasive procedures at a tertiary referral children’s hospital. Pericardiocentesis appeared to be a safe and effective procedure for significant PE and was feasible, including in neonates.

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