Indications:
(1) clinical cardiac tamponade
(2) effusions > 20 mm in diastole by echocardiography
(3) need to diagnose cause
Absolute contraindication:
(1) aortic dissection
Relative contraindications:
(1) uncorrected coagulopathy
(2) anticoagulation
(3) thrombocytopenia (< 50,000 per µL, higher with platelelt dysfunction)
(4) small effusions
(5) posterior effusion
(6) loculated effusion
Surgical draininage is usually indicated:
(1) traumatic hemopericardium
(2) purulent pericarditis
(3) concurrent pericardial resection
Aortic dissection (and significant contraindications) may require surgical drainage for major effusions.
