F-38 | Pericardiocentesis Drainage Technique on Post-Pericardiocentesis Mortality in Patients with Severe Pulmonary Hypertension

Pericardiocentesis may be associated with increased mortality in the setting of severe pulmonary hypertension (PH). There are no evidence-based guidelines for the prevention of post-pericardiocentesis hemodynamic collapse in these patients. We hypothesized that a gradual drainage technique over a period of days, rather than initial complete drainage, would cause less hemodynamic instability and therefore lower the risk of mortality. The purpose of this report is to assess the effect of pericardiocentesis drainage technique, gradual or complete, on post-pericardiocentesis mortality in patients with severe PH. All patients who underwent a pericardiocentesis at Thomas Jefferson University Hospital from March 2009 to May 2021 were identified. Patients were identified as having severe PH if pulmonary artery systolic pressure was greater than 60 mmHg prior to the procedure. Charts were analyzed for patient characteristics, echocardiographic and right heart catheterization data, drainage procedure, and post-procedural outcomes up to 48 hours. Fisher's exact test was used to compare mortality rates between the gradual and complete drainage groups. Twelve patients with severe PH were identified, average age 68 years. Three patients were drained gradually and nine completely. Four patients died within 48 hours following pericardiocentesis, three were in the gradual drainage group, one in the complete drainage group. P-value for the Fisher's exact test equaled 0.0182 (α = 0.05). We found higher mortality related to gradual drainage. The uneven distribution of comorbidities between the two groups and the non-randomized nature of this study are significant limitations. A randomized study may better answer this question.