Peripheral circulatory support and pericardial drainage for cardiac tamponade from blowout rupture: A case report

Background: Left ventricular free wall rupture is one of the most lethal complications of myocardial infarction and can cause catastrophic cardiac tamponade. Extracorporeal membrane oxygenation (ECMO) is often used to treat hemodynamic instability due to cardiac tamponade. However, elevated pericardial pressure collapses the right atrium, resulting in inadequate ECMO access and preventing stabilization of the circulation. Further, it interferes with the venous return from the superior vena cava (SVC), which increases the intracranial pressure and reduces cerebral perfusion levels. Case presentation: A 65-year-old man was hospitalized for out-of-hospital cardiac arrest. We used ECMO for cardiopulmonary resuscitation. After the establishment of ECMO, transthoracic echocardiography and left ventriculography revealed massive pericardial effusion. The treatment was supplemented with pericardial drainage since ECMO failed frequently in providing adequate suction. However, the blowout rupture caused the requirement of constant drainage from the pericardial catheter. Herein, we connected the venous cannula of ECMO and pericardial drainage catheter. The surgery was performed with stable circulation without the suction failure of ECMO. Conclusion We present a case wherein the combination of pericardial drainage and ECMO was used to maintain circulation in a patient with massive pericardial effusion due to cardiac rupture.