Intrapericardial Blood Re-transfused to Venous Circulation Through a Closed Circuit: A Life-Saving Management of Hemopericardium

J INVASIVE CARDIOL 2023;35(6):E321-E322. doi: 10.25270/jic/22.00300

Key words: pericardial effusion, tamponade, CTO, allotransfusion

A 78-year-old male developed hemopericardium (Figure 1A) and hemodynamic collapse after an unsuccessful chronic total occlusion percutaneous coronary intervention (CTO-PCI). Echocardiographically-assisted emergent subxiphoid pericardiocentesis was performed, and a dual-lumen central-venous catheter (CVC) was inserted into the pericardial space. As matched allogeneic blood was not readily available and the patient was in pre-arrest condition, direct re-transfusion of aspirated intrapericardial blood served as a life-saving option.

Figure 1B illustrates the hermetically closed aseptic circuit built by a male-to-male pre-heparinized tubing connector (white arrow) conjoining the pericardial CVC (green arrow) with a right femoral CVC (yellow arrow) and the three-way stop-cocks placed at each connection site (black arrows). Intrapericardial blood was being aspirated through a 10-mL luer-lock syringe and shifted into the systemic circulation being re-injected towards the femoral CVC, inverting hemodynamic compromise. Incidentally, a persistent right-to-left interatrial communication was detected (Figure 1C). The procedure was repeated several times within 24 hours tackling clinical and/or echocardiographic cardiac tamponade. Normal saline flashes towards the femoral CVC washed off the system after each re-transfusion process (Figure 1D). Notably, allogeneic blood transfusions deemed unnecessary, while infections, hemolysis, pulmonary, or systemic (through the atrial right-to-left shunt) embolic phenomena were not recorded. The patient was discharged on day 4 post-pericardiocentesis.

Our data indicate that treating PCI-induced hemopericardium with this closed-circuit technique is practical and safe. Intrapericardial mechanical defibrinogenation process and peri-procedural systemic anticoagulation possibly prevent thromboembolism. Direct autotransfusion limits acute blood loss and the requirement for blood allotransfusion and may prove lifesaving in the setting of severe hemodynamic instability.

Affiliations and Disclosures

From ¹General Hospital of Trikala, Thessalia, Greece.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted October 20, 2022.

Address for correspondence: Dimitrios Karelas, Riga Feraiou 13, Karditsa, Thessaly, Greece, Email: dim.f.karelas@gmail.com