Comparison of PLANE Technique versus Standard Echocardiography Guidance for Pediatric Pericardiocentesis

Stephen T. Clark; Jeffrey A. Alten; Santiago Borasino; Kristal M. Hock; Mark A. Law

doi:10.1055/s-0041-1736213

Journal of Pediatric Intensive Care, Table of Contents

J Pediatr Intensive Care 2024; 13(01): 032-036
DOI: 10.1055/s-0041-1736213

Original Article

Comparison of PLANE Technique versus Standard Echocardiography Guidance for Pediatric Pericardiocentesis

Authors

Stephen T. Clark

¹Division of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Alabama, United States
Jeffrey A. Alten

²Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Santiago Borasino

³Division of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
Kristal M. Hock

³Division of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
Mark A. Law

¹Division of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Alabama, United States

Abstract

Percutaneous pericardiocentesis remains a challenging and potentially dangerous procedure, particularly in small, critically ill patients. We present outcomes of the PLANE (pericardiocentesis using long-axis in-plane real-time echocardiography) technique for pediatric pericardiocentesis compared with a standard echocardiography (ECHO) guidance cohort. This was a retrospective chart review of all children undergoing percutaneous pericardiocentesis from March 2013 to February 2021 at a single center. A total of 78 procedures were performed, 52 utilizing PLANE technique and 26 utilizing standard ECHO-guidance technique. There was 100% technical success rate with only one minor complication for the entire cohort. Procedures were evenly split between the bedside intensive care unit and cardiac catheterization laboratory. PLANE technique was utilized in significantly younger (1.4 vs. 8.4 years, p = 0.008) and smaller (11.1 vs. 31.8 kg, p = 0.007) patients, as well as in most patients deemed high risk (postoperative < 7 days, extracorporeal membrane oxygenation (ECMO) support, and/or weight less than 5 kg; 19/22, p = 0.021). Other patient characteristics were similar between the two groups. There was a trend toward PLANE technique utilization by noncardiology trained operators. The PLANE technique for pediatric pericardiocentesis is safe and effective and can be effectively utilized in small and high-risk patient populations. The technical similarity to other long-axis ultrasound-guided procedures may facilitate adoption and mastery by critical care trained operators.

Keywords

pericardiocentesis - pediatric - intensive care - ultrasound

Full Text

References

References
1 Goldberg BB, Pollack HM. Ultrasonically guided pericardiocentesis. Am J Cardiol 1973; 31 (04) 490-493
2 Holm HH, Pedersen JF, Kristensen JK, Rasmussen SN, Hancke S, Jensen F. Ultrasonically guided percutaneous puncture. Radiol Clin North Am 1975; 13 (03) 493-503
3 Kristensen JK, Holm HH, Rasmussen SN, Barlebo H. Ultrasonically guided percutaneous puncture of renal masses. Scand J Urol Nephrol 1972; 6 (Suppl. 15) 15 , 49–56
4 Rasmussen SN, Holm HH, Kristensen JK, Barlebo H. Ultrasonically-guided liver biopsy. BMJ 1972; 2 (5812): 500-502
5 Alten JA, Borasino S, Gurley WQ, Law MA, Toms R, Dabal RJ. Ultrasound-guided femoral vein catheterization in neonates with cardiac disease. Pediatr Crit Care Med 2012; 13 (06) 654-659
6 Froehlich CD, Rigby MR, Rosenberg ES. et al. Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit. Crit Care Med 2009; 37 (03) 1090-1096
7 Gottlieb M, Holladay D, Peksa GD. Ultrasound-assisted lumbar punctures: a systematic review and meta-analysis. Acad Emerg Med 2019; 26 (01) 85-96
8 Law MA, Borasino S, McMahon WS, Alten JA. Ultrasound- versus landmark-guided femoral catheterization in the pediatric catheterization laboratory: a randomized-controlled trial. Pediatr Cardiol 2014; 35 (07) 1246-1252
9 Mercaldi CJ, Lanes SF. Ultrasound guidance decreases complications and improves the cost of care among patients undergoing thoracentesis and paracentesis. Chest 2013; 143 (02) 532-538
10 Shime N, Hosokawa K, MacLaren G. Ultrasound imaging reduces failure rates of percutaneous central venous catheterization in children. Pediatr Crit Care Med 2015; 16 (08) 718-725
11 Loukas M, Walters A, Boon JM, Welch TP, Meiring JH, Abrahams PH. Pericardiocentesis: a clinical anatomy review. Clin Anat 2012; 25 (07) 872-881
12 Tsang TS, Freeman WK, Sinak LJ, Seward JB. Echocardiographically guided pericardiocentesis: evolution and state-of-the-art technique. Mayo Clin Proc 1998; 73 (07) 647-652
13 Myers F, Aggarwal V, Bass JL. et al. Anatomic approach and outcomes in children undergoing percutaneous pericardiocentesis. Pediatr Cardiol 2021; 42 (04) 918-925
14 Tsang TS, Freeman WK, Barnes ME, Reeder GS, Packer DL, Seward JB. Rescue echocardiographically guided pericardiocentesis for cardiac perforation complicating catheter-based procedures. The Mayo Clinic experience. J Am Coll Cardiol 1998; 32 (05) 1345-1350
15 Tsang TS, El-Najdawi EK, Seward JB, Hagler DJ, Freeman WK, O'Leary PW. Percutaneous echocardiographically guided pericardiocentesis in pediatric patients: evaluation of safety and efficacy. J Am Soc Echocardiogr 1998; 11 (11) 1072-1077
16 Tsang TS, Barnes ME, Hayes SN. et al. Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo-guided pericardiocentesis for management: Mayo Clinic experience, 1979-1998. Chest 1999; 116 (02) 322-331
17 Tsang TS, Enriquez-Sarano M, Freeman WK. et al. Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc 2002; 77 (05) 429-436
18 Law MA, Borasino S, Kalra Y, Alten JA. Novel, long-axis in-plane ultrasound-guided pericardiocentesis for postoperative pericardial effusion drainage. Pediatr Cardiol 2016; 37 (07) 1328-1333
19 Zhang L, Zhang X-F, Liu Z. et al. High frequency ultrasound-guided pericardiocentesis performed in the sitting position: A novel apical approach. Clin Cardiol 2021; 44 (08) 1106-1112
20 Osman A, Wan Chuan T, Ab Rahman J, Via G, Tavazzi G. Ultrasound-guided pericardiocentesis: a novel parasternal approach. Eur J Emerg Med 2018; 25 (05) 322-327