Management of pericardial effusion in patients with solid tumor: An algorithmic, multidisciplinary approach results in reduced mortality after paradoxical hemodynamic instability Journal Article


Authors: Choe, J. K.; Byun, A. J.; Robinson, E.; Drake, L.; Tan, K. S.; McAleer, E. P.; Schaffer, W. L.; Liu, J. E.; Chen, L. L.; Buchholz, T.; Yohannes-Tomicich, J.; Yarmohammadi, H.; Ziv, E.; Solomon, S. B.; Huang, J.; Park, B. J.; Jones, D. R.; Adusumilli, P. S.
Article Title: Management of pericardial effusion in patients with solid tumor: An algorithmic, multidisciplinary approach results in reduced mortality after paradoxical hemodynamic instability
Abstract: Objective: This study compared outcomes in patients with solid tumor treated for pericardial effusion with surgical drainage versus interventional radiology (IR) percutaneous drainage and compared incidence of paradoxical hemodynamic instability (PHI) between cohorts. Background: Patients with advanced-stage solid malignancies may develop large pericardial effusions requiring intervention. PHI is a fatal and underreported complication that occurs following pericardial effusion drainage. Methods: Clinical characteristics and outcomes were compared between patients with solid tumors who underwent surgical drainage or IR percutaneous drainage for pericardial effusion from 2010 to 2020. Results: Among 447 patients, 243 were treated with surgical drainage, of which 27 (11%) developed PHI, compared with 7 of 204 patients (3%) who were treated with IR percutaneous drainage (P=0.002); overall incidence of PHI decreased during the study period. Rates of reintervention (30-day: 1% vs 4%; 90-day: 4% vs 6%, P=0.7) and mortality (30-day: 21% vs 17%, P=0.3; 90-day: 39% vs 37%, P=0.7) were not different between patients treated with surgical drainage and IR percutaneous drainage. For both interventions, OS was shorter among patients with PHI than among patients without PHI (surgical drainage, median [95% confidence interval] OS, 0.89 mo [0.33-2.1] vs 6.5 mo [5.0-8.9], P<0.001; IR percutaneous drainage, 3.7 mo [0.23-6.8] vs 5.0 mo [4.0-8.1], P=0.044). Conclusions: With a coordinated multidisciplinary approach focusing on prompt clinical and echocardiographic evaluation, triage with bias toward IR percutaneous drainage than surgical drainage and postintervention intensive care resulted in lower incidence of PHI and improved outcomes. © 2024 Lippincott Williams and Wilkins. All rights reserved.
Keywords: adult; controlled study; aged; middle aged; retrospective studies; major clinical study; mortality; solid tumor; neoplasm; neoplasms; incidence; retrospective study; surgery; surgical drainage; observational study; echocardiography; pericardial effusion; thorax surgery; pericardium; hemodynamics; percutaneous drainage; drainage; vascular disease; thoracic surgical procedures; paradoxical hemodynamic instability; pericardiotomy; complication; procedures; vascular diseases; humans; human; male; female; article; pericardiocentesis; solid malignant neoplasm; patient triage; malignant pericardial effusion; pericardial window
Journal Title: Annals of Surgery
Volume: 279
Issue: 1
ISSN: 0003-4932
Publisher: Lippincott Williams & Wilkins  
Date Published: 2024-01-01
Start Page: 147
End Page: 153
Language: English
DOI: 10.1097/sla.0000000000006114
PUBMED: 37800338
PROVIDER: scopus
PMCID: PMC11010720
DOI/URL:
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Prasad S. Adusumilli -- Source: Scopus
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MSK Authors
  1. Jennifer Liu
    118 Liu
  2. James Huang
    214 Huang
  3. Bernard J Park
    263 Park
  4. Stephen Solomon
    422 Solomon
  5. Leon Lin Chen
    52 Chen
  6. David Randolph Jones
    417 Jones
  7. Etay   Ziv
    111 Ziv
  8. Kay See   Tan
    241 Tan
  9. Jennie Kim Choe
    10 Choe
  10. Alexander J Byun
    7 Byun
  11. Lauren Drake
    2 Drake