Management of pericardial effusion

For purposes of this survey, readers were asked to assume that they were consulted on a hospitalized middle aged patient who has been diagnosed with stage IV non-small cell lung cancer. The patient has shortness of breath in the absence of an important pleural effusion. There is no endobronchial obstruction and there is no evidence for pulmonary embolism. A CT scan demonstrates a pericardial effusion. Although echocardiography demonstrates a large pericardial effusion with no evidence for tamponade, there is some mild diastolic collapse.

Almost all respondents manage pericardial effusions, and 90% of respondents believed that definitive management of this patient's effusion was appropriate. There were some individual/institutional differences in how definitive management was performed, but over 80% favored either pericardiocentesis or subxiphoid pericardiectomy. Surgical management favored a subxiphoid approach twice as often as a thoracoscopic approach. Few surgeons utilize either pericardioscopy or sclerosis. Most respondents favor tailoring the treatment approach to the degree of symptoms.

1. Do you manage patients with pericardial effusion?
		Response Percent	Response Count
Yes		98.5%	193
No		1.5%	3
	answered question		196
	skipped question		0

2. Do you believe definitive management of this effusion is appropriate?
		Response Percent	Response Count
Yes		89.3%	175
No		10.7%	21
	answered question		196
	skipped question		0

3. In your institution, which treatment option is most commonly used first?
		Response Percent	Response Count
Pericardiocentesis		36.7%	72
Balloon pericardiotomy		1.5%	3
Subxiphoid pericardiotomy		45.9%	90
Thoracoscopic pericardiotomy		14.3%	28
Pericardiectomy		1.5%	3
	answered question		196
	skipped question		0

4. What is your preferred method for surgically managing this effusion?
		Response Percent	Response Count
Subxiphoid pericardiotomy alone		58.5%	113
Subxiphoid percardiotomy with pericardioscopy		5.7%	11
Thoracoscopic pericardiotomy		31.1%	60
Pericardiectomy		4.7%	9
	answered question		193
	skipped question		3

5. If you manage such patients with a pericardiotomy, do you perform sclerosis as well?
		Response Percent	Response Count
Yes		16.3%	32
No		83.7%	164
	answered question		196
	skipped question		0

6. Does the degree of symptoms reported by the patient influence your choice of surgical intervention for such effusions?
		Response Percent	Response Count
Yes		67.9%	133
No		32.1%	63
	answered question		196
	skipped question		0

7. In what region is your surgical practice based?
		Response Percent	Response Count
North America		49.5%	97
Europe		20.4%	40
South America		11.7%	23
Asia		14.8%	29
Africa		3.6%	7
	answered question		196
	skipped question		0