Cardiac Tamponade Management

Clinical Guideline

V1.0

August 2020
Summary

Cardiac Tamponade Management Clinical Guideline V1.0

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1. Introduction

1.1 Cardiac tamponade is a clinical syndrome caused by the accumulation of fluid,

blood, pus, clots or gas in the pericardial space, resulting in reduced ventricular
filling and subsequent haemodynamic compromise. This includes a
haemodynamic spectrum ranging from incipient or preclinical tamponade (when
pericardial pressure equals right atrial pressure but it is lower than left atrial
pressure) to haemodynamic shock with significant reduction of stroke volume
and blood pressure, the latter representing a life-threatening medical
emergency.

1.2 The diagnosis of cardiac tamponade is essentially a clinical diagnosis requiring

echocardiographic confirmation of the initial diagnostic suspicion. In most
patients, cardiac tamponade should be diagnosed by clinical examination that
typically shows elevated systemic venous pressure, tachycardia, muffled heart
sounds and paradoxical arterial pulse. Systemic blood pressure may be normal,
decreased, or even elevated. Clinical signs may also include decreased
electrocardiographic voltage with electrical alternans and an enlarged cardiac
silhouette on chest X-ray with slow-accumulating effusions.

1.3 Once a clinical diagnosis of tamponade is suspected, an echocardiogram should

be performed without delay. The diagnosis is then confirmed by
echocardiographic demonstration of several 2D and Doppler-based findings (i.e.
evidence of pericardial effusion with variable cardiac chambers’ compression,
abnormal respiratory variation in tricuspid and mitral valve flow velocities, inferior
vena cava plethora).

1.4 This should immediately trigger On-call Consultant Cardiologist review in order
to stratify the patient risk, identify specific supportive and monitoring
requirements and guide the optimal timing and modality of pericardial drainage.
Treatment should be individualised, and thoughtful clinical judgement is
essential for the optimal outcome.

1.5 The overall mortality risk depends on the speed of diagnosis, the treatment
provided, and the underlying cause of the tamponade. Untreated, the condition
is rapidly and universally fatal.

1.6 The following pathway should be implemented for patients with suspected
cardiac tamponade.

1.7 This document provides guidance for any health care professional (regardless of
grade) involved in the clinical management of patients with suspected or proven
cardiac tamponade.

Cardiac Tamponade Management Clinical Guideline V1.0

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2. The Guidance

2.1 Clinical Presentation

2.1.1 The clinical presentation of pericardial tamponade is varied according to

the speed of pericardial fluid accumulation, the distensibility of the
pericardium, the filling pressures and compliance of the cardiac
chambers, and the aetiology of the effusion with possible symptoms that
may be related to the causative disease.

2.1.2 Pericardial diseases of any aetiology may cause cardiac tamponade, with
highly variable incidence reflecting the local epidemiological background,
which is well beyond the scope of this document. However, open cardiac
surgery and interventional procedures (i.e. percutaneous coronary
intervention, transcatheter aortic valve implantation,
pacemaker/implantable cardioverter defibrillator implantation, arrhythmias
ablation, endomyocardial biopsy) are emerging causes of cardiac
tamponade and should raise the suspicion in appropriate clinical setting.

2.1.3 The rate of pericardial fluid accumulation is critical for the clinical
presentation. If pericardial fluid is quickly accumulating such as for
iatrogenic perforations, the evolution is dramatic and only small amounts
of blood are responsible for a quick rise of intrapericardial pressure and
overt cardiac tamponade in minutes. This is due to a J-shaped pressure–
volume curve of the normal pericardium: after an initial short shallow
portion that allows the pericardium to stretch slightly in response to
physiological events, such as changes in posture or volume status, with
minimal pressure increase, the pericardium does not allow further sudden

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 increases of the volume without a marked increase in the intrapericardial
pressure. Thus a sudden increase of pericardial volume of 100-200 mL,
as in haemopericardium, may elevate pericardial pressure till 20 –30
mmHg resulting in acute or “surgical” cardiac tamponade. This steep rise
makes tamponade a “last-drop” phenomenon - the final increment
produces critical cardiac compression. On the contrary, a slowly
accumulating pericardial fluid allows the collection of a large effusion (up
to 1-2 L) in days to weeks before a significant increase in pericardial
pressure becomes responsible of symptoms and signs (chronic or
“medical” cardiac tamponade).

2.2 Symptoms

2.2.1 Classical symptoms include:

 Dyspnoea on exertion progressing to orthopnoea
 Chest pain, and/or fullness.

2.2.2 Additional occasional symptoms due to local compression may include:

 Nausea (diaphragm),
 Dysphagia (oesophagus)
 Hoarseness (recurrent laryngeal nerve) and
 Hiccups (phrenic nerve).

2.2.3 Non-specific symptoms include also:

 Cough
 Weakness
 Fatigue
 Anorexia and palpitations and reflect the compressive effect of the
pericardial fluid on contiguous anatomic structures or
 Reduced blood pressure and secondary sinus tachycardia.
 Decreased urine output, confusion and dysphoria may be seen as
well.
2.3 Signs

2.3.1 On physical examination classical signs include neck vein distention with
elevated jugular venous pressure at bedside examination, pulsus
paradoxus, and diminished heart sounds on cardiac auscultation.
Pericardial friction rubs are rarely heard; they can usually be detected in
patients with concomitant pericarditis.

2.3.2 Hypotension can be absolute or relative. Acute cardiac tamponade is

usually associated with low blood pressure (<90 mmHg) but may be only
slightly reduced in subacute, chronic tamponade. Hypertensive patients

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 may have normal to mildly elevated blood pressure concomitant to
cardiac tamponade.

2.3.3 Pulsus paradoxus has been classically defined as an exaggerated

inspiratory reduction of the systolic blood pressure in patients with
cardiac tamponade. The so-called paradox relates to the “waxing and
waning” of the peripheral pulse, in contrast to the unvarying strength of
the apical cardiac impulse. This is due to exaggerated ventricular
interdependence occurring in cardiac tamponade when overall volume
of cardiac chambers becomes fixed and any change in the volume of
one side of the heart causes the opposite changes in the other side (i.e.
inspiratory increase of venous return and right chambers with decreased
left chambers volume and reduced systemic blood pressure). To
measure pulsus paradoxus, patients lie semi-recumbent breathing
quietly. A blood pressure cuff is inflated > 20 mm Hg above systolic
pressure and deflated until the first Korotkoff sound is heard only during
expiration. At this pressure reading, if the cuff is not further deflated and
a pulsus paradoxus is present, the first Korotkoff sound is not audible
during inspiration. As the cuff is further deflated, the point at which the
first Korotkoff sound is audible during both inspiration and expiration is
recorded. If the difference between the first and second measurement is
greater than 10 mmHg, a pulsus paradoxus is present.

2.3.4 Beck’s triad is a complex of physical findings: raised jugular venous

pressure (JVP), hypotension, and quiet heart sounds due to a rapid
accumulation of pericardial fluid. This triad was classically identified in
“surgical” tamponade due to intrapericardial haemorrhage because of
trauma, myocardial or aortic rupture. The Beck’s triad may be lacking in
patients with “medical” tamponade’ with slowly accumulating pericardial
fluid.

2.3.5 Kussmaul’s sign is a paradoxical increase in venous distention and

pressure during inspiration. It is usually observed in patients with
constrictive pericarditis, but can also be seen in cardiac tamponade.

2.3.6 The physical signs of pulsus paradoxus and Kussmaul’s sign may be
easier to interpret in patients with intra-arterial lines, central venous
pressure monitoring and pulse oximetry. Respiratory variability in pulse-
oximetry waveform is noted in patients with pulsus paradoxus. This can
be particularly useful for aiding diagnosis in patients with atrial
fibrillation.

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2.4 Diagnostic tools

2.4.1 In a patient with clinical suspicion of cardiac tamponade, several

diagnostic tools are required.

2.4.2 ECG may show signs of pericarditis, with especially low QRS voltages
and electrical alternans. Both ECG signs are generally considered to be
an expression of the damping effect of pericardial fluid and swinging
heart.

2.4.3 Echocardiography is the single most useful diagnostic tool to identify

pericardial effusion and estimate its size, location and degree of
haemodynamic impact. Also, echocardiography is used to guide
pericardiocentesis with excellent safety and efficacy. Signs of
tamponade can be identified by echocardiography: swinging of the
heart, early diastolic collapse of the right ventricle, late diastolic collapse
of the right atrium, abnormal ventricular septal motion, exaggerated
respiratory variability in mitral (>25%) and tricuspid (>40%) inflow
velocities, inspiratory decrease and expiratory increase in pulmonary
vein diastolic forward flow, respiratory variation in ventricular chamber
size and aortic outflow velocity (echocardiographic pulsus paradoxus)
and inferior vena cava plethora (dilatation >20 mm and <50% reduction
in the diameter of IVC with respiratory phases).

2.4.4 Both transthoracic and transoesophageal echocardiography (TOE) have

high sensitivity in determining the various abnormalities seen with
tamponade. Transoesophageal echocardiography is also useful in
patients where transthoracic echocardiography is non-diagnostic. It is
typically used in post-cardiac surgery patients suspected of having
loculated effusions containing clots.

2.4.5 Chest X-ray findings may show cardiomegaly, a water bottle-shaped

heart, pericardial calcifications, or evidence of chest wall trauma.
However, the effusion has to reach at least 250 ml before it can be seen
on chest X-ray.

2.4.6 CT and CMR are generally unnecessary unless Doppler

echocardiography is not feasible.

2.4.7 Cardiac catheterization is rarely used to diagnose cardiac tamponade. It

will show equilibration of average diastolic pressure and characteristic
respiratory reciprocation of cardiac pressures, i.e. an inspiratory
increase on the right and a concomitant decrease on the left - the
proximate cause of pulsus paradoxus. Except in low-pressure

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 tamponade, diastolic pressures throughout the heart are usually in the
range of 15–30 mmHg.

2.5 Triage

2.5.1 The definitive treatment of cardiac tamponade involves drainage of the

pericardial fluid, preferably by needle pericardiocentesis, with the use of
echocardiographic or fluoroscopic guidance, and should be performed
without delay in unstable patients. Alternatively, drainage is performed
by a surgical approach, especially in some situations such as purulent
pericarditis or in urgent situations with bleeding into the pericardium.

2.5.2 However, management of cardiac tamponade can be challenging

because of the lack of the validated criteria for the risk stratification that
should guide clinicians in the decision-making process.

2.6 Which patients need immediate drainage of the pericardial effusion?

2.6.1 The decision to drain an effusion and to do it immediately, urgently, or

schedule the procedure electively must take into account the clinical
presentation, changes in the haemodynamic status over time (in the
range of several minutes to several hours depending on the aetiology),
the risk–benefit ratio of the procedure, and the echocardiographic
findings.

2.6.2 A triage system has been proposed by the ESC Working Group on
Myocardial and Pericardial Diseases in order to guide the timing of the
intervention and the possibility of transferring the patient to a referral
centre. Since cardiac tamponade can develop slowly, and the symptoms
and signs are neither highly sensitive nor specific, a scoring index was
introduced to guide the decision for pericardial drainage, based on
effusion size, echocardiographic assessment of haemodynamics, and
clinical factors.

2.6.3 This scoring system (figure 1.) is essentially based on expert consensus
and requires additional validation, but may be useful as an adjunctive
tool to aid in decision making when applied for the triage of cardiac
tamponade without haemodynamic shock (where immediate
pericardiocentesis is mandatory and life-saving).

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Figure 1. A three-step scoring system for the triage of patients requiring urgent percutaneous or
surgical drainage of pericardial effusion. Diagnosis of cardiac tamponade is based on the integration
of clinical symptoms, signs, and echo findings. Total score ≥6 indicates urgent pericardiocentesis in
the absence of contraindications. Contraindications include uncorrected coagulopathy, anticoagulant
therapy with INR >1.5, thrombocytopaenia <50 000/mm3, small, posterior, and loculated effusions,
or effusions resolving under anti-inflammatory treatment.

2.7 Recommendations:

2.7.1 Pericardial drainage is indicated for each case with established

diagnosis of cardiac tamponade. If the patient is haemodynamically
stable, the procedure should be performed within 12–24 h from
diagnosis, after obtaining laboratory results including the blood counts.

2.7.2 Indications for urgent surgical treatment of cardiac tamponade include

hemopericardium due to type A aortic dissection, ventricular free wall
rupture in acute myocardial infarction, trauma, or purulent effusion in
unstable septic patients, and loculated effusions that cannot be
managed percutaneously.

2.7.3 Aortic dissection and post-infarction rupture of the free wall are
contraindications to needle pericardiocentesis due to the potential risk of
aggravating the dissection or myocardial rupture via rapid pericardial
decompression and restoration of systemic arterial pressure. However, if
surgical management is not immediately available, or if the patient is too
unstable, pericardiocentesis and drainage of very small amounts of

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 haemopericardium can be attempted in order to maintain blood pressure
at around 90 mmHg as a bridge to emergency surgery.

2.7.4 In patients with cardiac tamponade, a stepwise scoring system may be

useful for the triage of patients. A total score ≥6 warrants immediate
pericardiocentesis in the absence of contraindications. In rapidly
deteriorating patients with iatrogenic hemopericardium or any other very
unstable patient, pericardial drainage should be performed without any
delay for laboratory tests but treating anticoagulation and prolonged INR
(as per the Trust Guidelines), and/or anaemia (plasma-free blood
transfusion) simultaneously with the drainage of the pericardium.

2.8 Is echocardiography sufficient for guidance of pericardiocentesis or should

patient be taken to the cardiac catheterization laboratory?

2.8.1 Echocardiography is mandatory to guide pericardiocentesis and select

the approach (intercostal vs. subxiphoid), except in case of life-
threatening tamponade.

2.8.2 Fluoroscopy can be considered for early diagnosis and rescue

pericardiocentesis especially for iatrogenic effusions after specific
interventional techniques (i.e. pacemaker implantation, percutaneous
coronary interventions), although echocardiography should be
immediately available as well.

2.9 Who should be transferred to specialized/tertiary institution or surgical service?

2.9.1 If the pericardial effusion cannot be reached by a needle or a catheter,

surgical drainage is required, usually through a subcostal incision.
Furthermore, surgical drainage is desirable in patients with purulent
pericardial fluid, intrapericardial bleeding, and in those with clotted
hemopericardium or thoracic conditions that make pericardiocentesis
difficult or ineffective.

2.9.2 Open surgical drainage has the additional benefit of resecting a portion
of the pericardium for histological examination, breaking up loculations,
evacuation of haematoma, and placing a large drainage tube, which is
especially important in purulent pericarditis.

2.10 What type of medical support is necessary during transportation?

If the patient is clinically stable to allow pericardial drainage to be delayed,

they should be promptly transferred to a specialized institution accompanied
by a physician. During the transportation, the patient should be protected from

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 heat and dehydration, and spared from any unnecessary stress. ECG and
blood pressure monitoring should be performed throughout the transfer time.

2.11 Management

Immediate pericardiocentesis in peri-arrest patients and those with

haemodynamic shock secondary to cardiac tamponade is mandatory and
should be performed on site as a life-saving intervention. All other patients
should be transferred to Coronary Care Unit (or Intensive Care Unit, subject
to bed availability) for monitoring and definitive treatment.

2.12 Supportive measures

2.12.1 Medical management is only a temporary measure for tamponade

patients while waiting for pericardiocentesis and should not be allowed to
substitute for or delay the definitive treatment.

2.12.2 Hypotensive patients (systolic arterial pressure <100 mmHg) with

hypovolaemia can be treated with a low volume (250-500 ml) of normal
saline as it has been demonstrated to improve haemodynamic
parameters. However, the infusion of higher volumes may increase
wedge pressure and intrapericardial pressure, and reduce cardiac
output.

2.12.3 Intravenous administration of diuretics is contraindicated and could be

fatal in patients on the edge of their compensatory mechanism in
tamponade.

2.12.4 Both dopamine and dobutamine improve haemodynamics: dobutamine

has greater beta activity and, therefore, it may be preferable. However,
the usefulness of inotropes is generally limited because endogenous
adrenergic stimulation is already enhanced under tamponade
conditions.

2.12.5 Antibiotic prophylaxis is not indicated unless the procedure has been
carried out in an emergency setting without adequate asepsis.

2.13 Monitoring requirements and nursing interventions:

2.13.1 Nurses have a primary role in monitoring patients for any deterioration in
clinical status.

2.13.2 Keep patients with cardiac tamponade who are hypotensive on bed rest
with their legs elevated above heart level to increase venous blood

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 return to the heart. Patients who aren’t hypotensive should be
maintained on bed rest in semi-Fowler’s position or leaning forward.

2.13.3 Assess for respiratory distress and prepare to administer supplemental

oxygen to maintain the patient’s SpO2 above 92%.

2.13.4 Place the patient on continuous cardiac monitoring.

2.13.5 Monitor the ECG and BP for arrhythmias, hypotension, and electrical
alternans.

2.13.6 Allay the patient’s anxiety and pain. If the patient is anxious, a mild
anxiolytic may help. Pain management is a primary treatment goal, but
give pain medications with caution; opioids such as morphine can
contribute to hypotension.

2.13.7 Anticipate preparing the patient for emergent pericardiocentesis with

echocardiographic guidance.

2.13.8 Secure two large-bore intravenous lines for fluid administration.

2.13.9 Prepare for volume repletion with isotonic solutions such as 0.9%
sodium chloride solution, or inotropic support with agents such as IV
dobutamine, depending on the patient’s hemodynamic status.

2.13.10 Monitor intake and output closely, especially hourly urine outputs.

2.14 Patient monitoring and assessment:

2.14.1 Continuously monitor ECG for dysrhythmia formation, which may result
from myocardial ischaemia secondary to epicardial coronary artery
compression.

2.14.2 Monitor the BP every 15 minutes during the acute phase (for 2-3 hours),
then every 30 minutes if stable.

2.14.3 Monitor for pulsus paradoxus during manual BP reading (or via arterial
tracing).

2.14.4 Monitor urine output hourly; a drop in urine output may indicate
decreased renal perfusion as a result of decreased stroke volume
secondary to cardiac compression.

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 2.14.5 Assess cardiovascular status: monitor for jugular vein distention and
presence of Kussmaul’s sign.

2.14.6 Note skin temperature, color, and capillary refill.

2.14.7 Assess level of consciousness for changes that may indicate decreased
cerebral perfusion.

2.14.8 Check blood lactate level, U&E and liver transaminases every 8 hours.

2.15 Outcome criteria:

 Patient alert and oriented

 Skin warm and dry
 Pulses strong and equal bilaterally
 Capillary refill <3 sec
 HR 60 to 100 beats/min
 BP 90 to 120 mm Hg
 Pulse pressure 30 to 40 mm Hg
 Urine output 30 ml/hr or 1 ml/kg/hr

2.16 Pericardiocentesis

2.16.1 Pericardiocentesis was performed for decades as a “blind” procedure,

almost exclusively from the subxiphoid area. Currently however,
echocardiography is widely available and except in very rare urgent
cases with clear diagnosis (e.g. complications of interventional
procedures) or in case of a cardiac arrest, pericardiocentesis should not
be attempted without echocardiographic guidance.

2.16.2 Echocardiography should identify distribution and size of the effusion.

The most useful location for pericardiocentesis is the one closest to the
largest amount of the effusion, and therefore echocardiography identifies
the most suitable approach for pericardiocentesis (in most patients
subxiphoid or apical).

2.16.3 Urgent pericardiocentesis can be safely and successfully performed as a

simple echo-guided procedure or the patient can be taken to the
catheterization laboratory and fluoroscopy (real-time) guidance be
added to the orientation initially obtained by echocardiography.

2.16.4 Prior preparation is essential for the safe performance of

pericardiocentesis. It should only be performed by trained staff, unless

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 the patient is in pulseless electrical activity cardiac arrest.

2.16.5 The platelet count and coagulation profile should be checked. Packed
red cell units should be readily available before starting non-emergency
procedures. Patient electrocardiographic monitoring is required in an
appropriate environment with resuscitation equipment. A central venous
catheter is not essential, but can be useful for monitoring right atrial
pressure and permitting rapid infusion of fluids and drugs if indicated.

2.16.6 A preliminary echocardiographic evaluation is recommended with

different views to assess the size and distribution of the effusion, to
select the proper entry site and also to monitor the procedure. The
patient should be placed in a semi-reclining position at an angle of about
30° and slightly rotated leftwards to enhance fluid collection in the
inferior-anterior part of the chest.

2.16.7 Any percutaneous site that is selected should avoid the internal
mammary artery (3-5 cm from the parasternal border) and the vascular
bundle at the inferior margin of each rib. After appropriate disinfection of
the operative field, a local anaesthetic is administered at the puncture
site.

2.16.8 The trajectory of the needle is defined by the angle between the probe
and the chest wall. The optimal needle trajectory should be visualised in
the operator’s mind, and then a 16-18 gauge, Teflon-sheathed needle
with an attached saline-filled syringe advanced in the direction of the
fluid-filled space.

2.16.9 When fluid is aspirated, the needle should be advanced approximately 2

mm further. The sheath should be advanced over the needle and the
steel core withdrawn, maintaining only the sheath in the pericardial
space. A guidewire should be advanced through the sheath, which can
then be removed. A bloody aspirate may indicate myocardial puncture or
haemorrhagic pericardial effusion.

2.16.10 The extracardiac position of the tip can be confirmed by injecting 5 ml

of agitated saline infusion: the bubbles can be visualised through
echocardiography in the pericardial space. A small incision should be
made at the entry site followed by the introduction of a sheathed dilator
(6 Fr to 8 Fr) over the guide.

2.16.11 The dilator should be removed and a pigtail catheter inserted directly
into the sheath. The pericardial effusion is aspirated by syringe suction
and the catheter is closed after flushing with 5 ml of heparinised saline.

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2.17 Complications

2.17.1 The rate of major complications for echo-guided or fluoroscopic

pericardiocentesis is 0.3-3.9%, and the rate of minor complications is
0.4-20%. The most serious complications include death, injury of the
cardiac chambers, laceration of the coronary arteries or intercostal
vessels, puncture of the abdominal viscera or peritoneal cavity,
pneumothorax requiring chest tube placement, pneumopericardium,
ventricular arrhythmias and pericardial decompression syndrome.
Myocardial and coronary puncture may initially be silent and present
with delayed haemopericardium or intrapericardial thrombus.

2.17.2 Pericardial decompression is a rare, potentially life-threatening

syndrome characterised by wide clinical scenarios (from pulmonary
oedema to cardiogenic shock). It generally develops after a successful
pericardial drainage, from a few hours to days later. The mechanism of
this situation is not yet well understood. However, the simplest
explanation is an acute left ventricular overload due to an increased
right-sided preload associated with a persistent catecholaminergic
peripheral vasoconstriction. To date, there are no effective
recommendations to prevent this syndrome except to remove enough
fluid to normalise the central venous and systemic blood pressure (not
>1 L) and to complete the removal in the subsequent few hours.

2.17.3 Minor complications include transient vasovagal hypotension and

bradycardia, supraventricular arrhythmias, pneumothorax without
haemodynamic instability, and pleuropericardial fistulas.

2.18 Post-procedure management

Aspiration is repeated every four to six hours, and the catheter can be
removed once the drainage has decreased to less than 25 to 30 ml in 24
hours. Pericardial catheter care is the same as central venous catheter care.
After the procedure, all patients undergo chest radiography to exclude the
presence of pneumothorax.

2.19 Pearls and pitfalls

2.19.1 Respiratory management

Increased intrathoracic pressures during the inspiratory phase of mechanical
ventilation can decrease cardiac output by up to 25% in patients with
tamponade. Patients with suspected cardiac tamponade, therefore, should not

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 receive positive-pressure ventilation unless absolutely necessary in order to
avoid further haemodynamic compromise.

2.19.2 Prevention of recurrence

Pericardial drainage for 24 to 72 hours is sufficient to avoid recurrence of

cardiac tamponade in the majority of cases. The recurrence rate after the
initial procedure is 27-55% for patients who undergo simple
pericardiocentesis, and 12-24% for those who have extended drainage. The
omission of extended catheter drainage is an important independent predictor
of recurrence. It is important to empty the pericardial sac as completely as
possible, leaving the catheter in place up to 72 hours or more if the fluid has a
rate of accumulation greater than 30 mL in 24 hours, knowing that
complications associated with the use of a pericardial catheter are rare.

3. Monitoring compliance and effectiveness

Element to be Guidelines outlined in this document
monitored
Lead Clinical Lead
Tool Audit of care delivered including Euroscore usage, blood
monitoring, and cessation of anticoagulation, timing of
procedure since diagnosis and patient outcomes recorded on
word/excel spreadsheet.
Frequency For every patient who present with diagnosis requiring
pericardiocentesis.
Reporting Outcome will be reported via Cardiology Mortality and Morbidity
arrangements meeting.
Acting on Any concerns identified during audit will be acted upon Clinical
recommendations Lead.
and Lead(s)
Change in practice Via Cardiology Mortality and Morbidity meeting.
and lessons to be
shared

4. Equality and Diversity

4.1 This document complies with the Royal Cornwall Hospitals NHS Trust
service Equality and Diversity statement which can be found in the 'Equality,
Inclusion & Human Rights Policy' or the Equality and Diversity website.

4.2 Equality Impact Assessment

The Initial Equality Impact Assessment Screening Form is at Appendix 2.

Cardiac Tamponade Management Clinical Guideline V1.0

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Appendix 1. Governance Information
Document Title Cardiac Tamponade Management Clinical Guideline V1.0

This document
replaces (exact title of New Document
previous version):
Date
18 August 2020
Issued/Approved:

Date Valid From: August 2020

Date Valid To: August 2023

Directorate /
Department
Dr Zeljko Baricevic, Consultant Cardiologist
responsible
(author/owner):
Contact details: 01872 252536
This document provides guidance for any professional
Brief summary of
involved in the clinical management of patients presenting
contents
with suspected or proven cardiac tamponade.
Cardiology
Suggested Keywords: Cardiac tamponade
Pericardiocentesis
RCHT CFT KCCG
Target Audience

Executive Director
responsible for Medical Director
Policy:
Approval route for Consultant Cardiologists
consultation and Members of the Cardiology Speciality Governance group
ratification: Medical Services Governance and Quality
General Manager
confirming approval Sharon Matson
processes
Name of Governance
Lead confirming
approval by specialty
Becky Osborne
and care group
management
meetings
Links to key external
https://academic.oup.com/eurheartj/article/36/42/2921/2293375
standards

Cardiac Tamponade Management Clinical Guideline V1.0

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 1. Massimo Imazio, Yehuda Adler. Management of
pericardial effusion, European Heart Journal, Volume
34, Issue 16, 21 April 2013, Pages 1186–1197.
2. Ristic AD, Imazio M, Adler Y, et al. Triage strategy for
urgent management of cardiac tamponade: a position
statement of the European Society of Cardiology
Working Group on Myocardial and Pericardial
Diseases. Eur Heart J. 2014 Sep 7:35(34):2279-84.
3. Yehuda Adler, Philippe Charron, Massimo Imazio, et
Related Documents:
al. ESC Scientific Document Group, 2015 ESC
Guidelines for the diagnosis and management of
pericardial diseases: The Task Force for the Diagnosis
and Management of Pericardial Diseases of the
European Society of Cardiology (ESC)
Endorsed by: The European Association for Cardio-
Thoracic Surgery (EACTS), European Heart Journal,
Volume 36, Issue 42, 7 November 2015, Pages 2921–
2964.
Training Need
No
Identified?
Publication Location
(refer to Policy on
Internet & Intranet  Intranet Only
Policies – Approvals
and Ratification):
Document Library
Clinical / Cardiology
Folder/Sub Folder

Version Control Table

Version Changes Made by

Date Summary of Changes
No (Name and Job Title)
Dr Zeljko Baricevic,
June 2020 V1.0 Initial version
Consultant Cardiologist

All or part of this document can be released under the Freedom of Information Act 2000
This document is to be retained for 10 years from the date of expiry.
This document is only valid on the day of printing

Controlled Document
This document has been created following the Royal Cornwall Hospitals NHS Trust Policy for the
Development and Management of Knowledge, Procedural and Web Documents (The Policy on
Policies). It should not be altered in any way without the express permission of the author or their Line
Manager.

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Appendix 2. Equality Impact Assessment
Section 1: Equality Impact Assessment Form
Name of the strategy / policy /proposal / service function to be assessed
Cardiac Tamponade Management Clinical Guideline V1.0
Directorate and service area: Is this a new or existing Policy?
Specialist Medicine, Cardiology New
Name of individual/group completing EIA Contact details:
Dr Zeljko Baricevic, Consultant Cardiologist 01872 252536
1. Policy Aim To improve the outcome of patients presenting with cardiac
Who is the strategy / policy / tamponade
proposal / service function
aimed at? Aimed at any health care professional involved in the clinical
management of RCHT facing patients who present with
suspected or proven cardiac tamponade.
2. Policy Objectives To provide clear speciality agreed guidelines and pathways
for the diagnosis and clinical management of patients with
cardiac tamponade presenting to Royal Cornwall Hospitals
NHS Trust.
3. Policy Intended Outcomes All clinical staff working in cardiology are knowledgeable and
confident in their understanding of cardiac tamponade
management

Standardised care, provision of appropriate and timely

interventions, better education, reduction in morbidity and
mortality of patients with cardiac tamponade.
4. How will you measure the
outcome? Outlined in section 4 of this document.

5. Who is intended to benefit Patients presenting with cardiac tamponade and health care
from the policy? professionals involved in their care.

6a). Who did you consult Local External

Workforce Patients Other
with? groups organisations


b). Please list any groups who Consultant Cardiologists

have been consulted about Cardiology Governance Meeting
this procedure.

c). What was the outcome of Agreed

the consultation?

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7. The Impact
Please complete the following table. If you are unsure/don’t know if there is a negative impact
you need to repeat the consultation step.
Are there concerns that the policy could have a positive/negative impact on:
Protected
Yes No Unsure Rationale for Assessment / Existing Evidence
Characteristic
Age 
Sex (male, female
non-binary, asexual 
etc.)
Gender

reassignment
Race/ethnic
communities 
/groups
Disability
(learning disability,
physical disability,
sensory impairment,

mental health
problems and some
long term health
conditions)
Religion/

other beliefs
Marriage and civil

partnership
Pregnancy and

maternity
Sexual orientation
(bisexual, gay, 
heterosexual, lesbian)
If all characteristics are ticked ‘no’, and this is not a major working or service
change, you can end the assessment here as long as you have a robust rationale
in place.I am confident that section 2 of this EIA does not need completing as there are no
highlighted risks of negative impact occurring because of this policy.

Name of person confirming result of initial

Dr Zeljko Baricevic, Consultant Cardiologist
impact assessment:
If you have ticked ‘yes’ to any characteristic above OR this is a major working or
service change, you will need to complete section 2 of the EIA form available here:
Section 2. Full Equality Analysis For guidance please refer to the Equality Impact
Assessments Policy (available from the document library) or contact the Human
Rights, Equality and Inclusion Lead debby.lewis@nhs.net

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