Journal of Anesthesia

, Volume 29, Issue 6, pp 944–952 | Cite as

Factors affecting survival in pediatric cardiac tamponade caused by central venous catheters

  • Kenji KayashimaEmail author
Review Article


Pediatric central venous catheter (CVC) placement is useful but associated with complications such as cardiac tamponade. We aimed to identify risk factors for death in cardiac tamponade. Published articles on pediatric CVC-associated cardiac tamponade were obtained by searching PubMed and Google and retrospectively reviewed to analyze risk factors for death. Factors examined for their effect on mortality risk included patient age, weight, CVC size, days from CVC insertion to tamponade occurrence, substances administered, insertion site, treatment, CVC material, and initial CVC tip position. Of 110 patients reported in 62 articles, 69 survived and 41 died. Among survivors, 55 of 69 patients were treated; among deaths, only 7 of 38 (OR 537.9, 95 % CI 29.3–9,877, p < 0.0001). Multiple regression analysis in 44 cases showed that treatment (p < 0.0001) and initial CVC tip position (p = 0.020) were independent predictive factors related to improved cardiac tamponade survival. Past studies have mainly discussed how to avoid pediatric cardiac tamponade; by contrast, the present study focused on how to avoid deaths. The findings of this review suggest that cardiac tamponade survival is better when tamponade is detected early and treated promptly and might be affected by initial CVC tip position.


Pediatric Cardiac tamponade Central venous catheter Survival rate 


  1. 1.
    Booth SA, Norton B, Mulvey DA. Central venous catheterization and fatal cardiac tamponade. Br J Anaesth. 2001;87:298–302.CrossRefPubMedGoogle Scholar
  2. 2.
    Collier PE, Blocker SH, Graff DM, Doyle P. Cardiac tamponade from central venous catheters. Am J Surg. 1998;176:212–4.CrossRefPubMedGoogle Scholar
  3. 3.
    van Haeften TW, van Pampus EC, Boot H, van Schijndel RJS, Thijs LG. Cardiac tamponade from misplaced central venous line in pericardiophrenic vein. Arch Intern Med. 1988;148:1649–50.CrossRefPubMedGoogle Scholar
  4. 4.
    Yoder D. Cardiac perforation and tamponade: the deadly duo of central venous catheters. Int J Trauma Nurs. 2001;7:108–12.CrossRefPubMedGoogle Scholar
  5. 5.
    Agarwal R, Downe L. Use of percutaneous silastic central venous catheters in the management of newborn infants. Indian Pediatr. 2001;38:889–92.Google Scholar
  6. 6.
    Mupanemunda RH, Mackanjee HR. A life-threatening complication of percutaneous central venous catheters in neonates. Am J Dis Child. 1992;146:1414–5.PubMedGoogle Scholar
  7. 7.
    Darling JC, Newell SJ, Mohamdee O, Uzun O, Cullinane CJ, Dear PR. Central venous catheter tip in the right atrium: a risk factor for neonatal cardiac tamponade. J Perinatol. 2001;21:461–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Cartwright DW. Central venous lines in neonates: a study of 2186 catheters. Arch Dis Child Fetal Neonatal Ed. 2004;89:F504–8.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Weil BR, Ladd AP, Yoder K. Pericardial effusion and cardiac tamponade associated with central venous catheters in children: an uncommon but serious and treatable condition. J Pediatr Surg. 2010;45:1687–92.CrossRefPubMedGoogle Scholar
  10. 10.
    Warren M, Thompson KS, Popek EJ, Vogel H, Hicks J. Pericardial effusion and cardiac tamponade in neonates: sudden unexpected death associated with total parenteral nutrition via central venous catheterization. Ann Clin Lab Sci. 2013;43:163–71.PubMedGoogle Scholar
  11. 11.
    Wirrell EC, Pelausa EO, Allen AC, Stinson DA, Hanna BD. Massive pericardial effusion as a cause for sudden deterioration of a very low birthweight infant. Am J Perinatol. 1993;10:419–23.PubMedGoogle Scholar
  12. 12.
    Sullivan CA, Konefal SH Jr. Cardiac tamponade in a newborn: a complication of hyperalimentation. JPEN J Parenter Enteral Nutr. 1987;11:319–21.CrossRefPubMedGoogle Scholar
  13. 13.
    Goutail-Flaud MF, Sfez M, Berg A, Laguenie G, Couturier C, Barbotin-Larrieu F, Saint-Maurice C. Central venous catheter-related complications in newborns and infants: a 587-case survey. J Pediatr Surg. 1991;26:645–50.CrossRefPubMedGoogle Scholar
  14. 14.
    van Engelenburg KC, Festen C. Cardiac tamponade: a rare but life-threatening complication of central venous catheters in children. J Pediatr Surg. 1998;33:1822–44.CrossRefPubMedGoogle Scholar
  15. 15.
    Sutcliffe AG. Total parenteral nutrition tamponade. J R Soc Med. 1995;88:173P–4P.PubMedCentralPubMedGoogle Scholar
  16. 16.
    Connolly B, Amaral J, Walsh S, Temple M, Chait P, Stephens D. Influence of arm movement on central tip location of peripherally inserted central catheters (PICCs). Pediatr Radiol. 2006;36:845–50.CrossRefPubMedGoogle Scholar
  17. 17.
    Nadroo AM, Glass RB, Lin J, Green RS, Holzman IR. Changes in upper extremity position cause migration of peripherally inserted central catheters in neonates. Pediatrics. 2002;110(1 Pt 1):131–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Onal EE, Saygili A, Koç E, Türkyilmaz C, Okumus N, Atalay Y. Cardiac tamponade in a newborn because of umbilical venous catheterization: is correct position safe? Paediatr Anaesth. 2004;14:953–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Opitz JC, Toyama W. Cardiac tamponade from central venous catheterization: two cases in premature infants with survival. Pediatrics. 1982;70:139–40.PubMedGoogle Scholar
  20. 20.
    Nowlen TT, Rosenthal GL, Johnson GL, Tom DJ, Vargo TA. Pericardial effusion and tamponade in infants with central catheters. Pediatrics. 2002;110:137–42.CrossRefPubMedGoogle Scholar
  21. 21.
    Kayashima K, Imai K. Evaluation of mechanical complications during pediatric central venous catheter placement from 1994 to 2013. Int J Anesthesiol Res. 2013;1:36–46.Google Scholar
  22. 22.
    Beardsall K, White DK, Pinto EM, Kelsall AW. Pericardial effusion and cardiac tamponade as complications of neonatal long lines: are they really a problem? Arch Dis Child Fetal Neonatal Ed. 2003;88:F292–5.PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Askegard-Giesmann JR, Caniano DA, Kenney BD. Rare but serious complications of central line insertion. Semin Pediatr Surg. 2009;18:73–83.CrossRefPubMedGoogle Scholar
  24. 24.
    Altman RP, Randolph JG. Application and hazards of total parenteral nutrition in infants. Ann Surg. 1971;174:85–90.PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Fischer GW, Scherz RG. Neck vein catheters and pericardial tamponade. Pediatrics. 1973;52:868–71.PubMedGoogle Scholar
  26. 26.
    Purohit DM, Levkoff AM. Pericardial effusion complicating umbilical venous catheterization. Arch Dis Child. 1977;52:520.PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Bar-Joseph G, Galvis AG. Perforation of the heart by central venous catheters in infants: guidelines to diagnosis and management. J Pediatr Surg. 1983;18:284–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Abu-Dalu K, Eid A, Goitein K, Schiller M. Pericardial tamponade complicating central venous catheterization in a newborn infant. Z Kinderchir. 1984;39:135–6.PubMedGoogle Scholar
  29. 29.
    Agarwal KC, Khan MA, Falla A, Amato JJ. Cardiac perforation from central venous catheters: survival after cardiac tamponade in an infant. Pediatrics. 1984;73:333–8.PubMedGoogle Scholar
  30. 30.
    Leibovitz E, Ashkenazi A, Levin S, Nissim F. Fatal pericardial tamponade complicating total parenteral nutrition via a silastic central vein catheter. J Pediatr Gastroenterol Nutr. 1988;7:306–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Garg M, Chang CVC, Merritt RJ. An unusual case presentation: pericardial tamponade complicating central venous catheter. J Perinatol. 1989;9:456–7.PubMedGoogle Scholar
  32. 32.
    Rogers BB, Berns SD, Maynard EC, Hansen TW. Pericardial tamponade secondary to central venous catheterization and hyperalimentation in a very low birthweight infant. Pediatr Pathol. 1990;10:819–23.CrossRefPubMedGoogle Scholar
  33. 33.
    Giacoia GP. Cardiac tamponade and hydrothorax as complications of central venous parenteral nutrition in infants. JPEN J Parenter Enteral Nutr. 1991;15:110–3.CrossRefPubMedGoogle Scholar
  34. 34.
    Aiken G, Porteous L, Tracy M, Richardson V. Cardiac tamponade from a fine silastic central venous catheter in a premature infant. J Paediatr Child Health. 1992;28:325–7.CrossRefPubMedGoogle Scholar
  35. 35.
    Byard RW, Bourne AJ, Moore L, Little KE. Sudden death in early infancy due to delayed cardiac tamponade complicating central venous line insertion and cardiac catheterization. Arch Pathol Lab Med. 1992;116:654–6.PubMedGoogle Scholar
  36. 36.
    Beattie PG, Kuschel CA, Harding JE. Pericardial effusion complicating a percutaneous central venous line in a neonate. Acta Paediatr. 1993;82:105–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Fukuda H, Kasuda H, Shimizu R. Right ventricular perforation and cardiac tamponade caused by a central venous catheter. Masui. 1993;42:280–3.PubMedGoogle Scholar
  38. 38.
    Cherng YG, Cheng YJ, Chen TG, Wang CM, Liu CC. Cardiac tamponade in an infant. A rare complication of central venous catheterisation. Anaesthesia. 1994;49:1052–4.CrossRefPubMedGoogle Scholar
  39. 39.
    Chang LY, Horng YC, Chou YH, Tsou KI. Umbilical venous line-related pericardial effusion in a premature neonate: report of a case. J Formos Med Assoc. 1995;94:355–7.PubMedGoogle Scholar
  40. 40.
    Fioravanti J, Buzzard CJ, Harris JP. Pericardial effusion and tamponade as a result of percutaneous silastic catheter use. Neonatal Netw. 1998;17:39–42.PubMedGoogle Scholar
  41. 41.
    Pesce C, Mercurella A, Musi L, Campobasso P, Negri M. Fatal cardiac tamponade as a late complication of central venous catheterization: a case report. Eur J Pediatr Surg. 1999;9:113–5.CrossRefPubMedGoogle Scholar
  42. 42.
    Aggarwal R, Downe L. Use of percutaneous silastic central venous catheters in the management of newborn infants. Indian Pediatr. 2001;38:889–92.PubMedGoogle Scholar
  43. 43.
    Kabra NS, Kluckow MR. Survival after an acute pericardial tamponade as a result of percutaneously inserted central venous catheter in a preterm neonate. Indian J Pediatr. 2001;68:677–80.CrossRefPubMedGoogle Scholar
  44. 44.
    Leipälä JA, Petäjä J, Fellman V. Perforation complications of percutaneous central venous catheters in very low birthweight infants. J Paediatr Child Health. 2001;37:168–71.CrossRefPubMedGoogle Scholar
  45. 45.
    Lun KS, Lee WH. Cardiac tamponade secondary to umbilical vein catheterization in a premature newborn: a case report. HK J Paediatr. 2002;7:98–100.Google Scholar
  46. 46.
    Madhok AB, Chabbra M, Lourdes C. Unusual complication of umbilical venous catheterization leads to pericardial tamponade. Internet J Pediatr Neonat. 2002;2:8891.Google Scholar
  47. 47.
    Schulman J, Munshi UK, Eastman ML, Farina M. Unexpected resistance to external cardiac compression may signal pericardial tamponade. J Perinatol. 2002;22:679–81.CrossRefPubMedGoogle Scholar
  48. 48.
    Au SH, Sun DC, Lue HC. Cardiac tamponade from percutaneous central venous catheterization: report of one case. Acta Paediatr Taiwan. 2003;44:235–7.PubMedGoogle Scholar
  49. 49.
    Pezzati M, Filippi L, Chiti G, Dani C, Rossi S, Bertini G, Rubaltelli FF. Central venous catheters and cardiac tamponade in preterm infants. Intensive Care Med. 2004;30:2253–6.CrossRefPubMedGoogle Scholar
  50. 50.
    Pignotti MS, Messeri A, Donzelli G. Thoracentesis in pericardial and pleural effusion caused by central venous catheterization: a less invasive neonatal approach. Paediatr Anaesth. 2004;14:349–51.CrossRefPubMedGoogle Scholar
  51. 51.
    Alzaydi AM, Mersal AY, Al-Saedi SA, El-Naggar WA. Survival of 2 extreme preterm neonates with cardiac tamponade as a complication of percutaneous central venous catheterization. Saudi Med J. 2005;26:476–7.PubMedGoogle Scholar
  52. 52.
    Colomina MJ, Godet C, Pellisé F. González Posada MA, Bagó J, Villanueva C. Cardiac tamponade associated with a peripheral vein central venous catheter. Paediatr Anaesth. 2005;15:988–92.CrossRefPubMedGoogle Scholar
  53. 53.
    Traen M, Schepens E, Laroche S, van Overmeire B. Cardiac tamponade and pericardial effusion due to venous umbilical catheterization. Acta Paediatr. 2005;94:626–8.CrossRefPubMedGoogle Scholar
  54. 54.
    Al Nemri AM. Ignacio LC, Al Zamil FA, Al Jarallah AS. Rare but fatal complication of umbilical venous catheterization. Congenit Heart Dis. 2006;1:180–3.CrossRefPubMedGoogle Scholar
  55. 55.
    Hong EJ, Lee KA, Bae IH, Kim MJ, Han HS. Umbilical venous line-related pleural and pericardial effusion causing cardiac tamponade in a premature neonate: a case report. Korean J Pediatr. 2006;49:686–90.CrossRefGoogle Scholar
  56. 56.
    Sehgal A, Cook V, Dunn M. Pericardial effusion associated with an appropriately placed umbilical venous catheter. J Perinatol. 2007;27:317–9.CrossRefPubMedGoogle Scholar
  57. 57.
    Suresh N, Shanmugasundaram R, Namasivayam S. Pericardial tamponade in neonate following migration of a sialastic central venous catheter. Indian Pediatr. 2007;44:45–6.PubMedGoogle Scholar
  58. 58.
    Monteiro AJ, Canale LS, Barbosa R, Méier M. Cardiac tamponade caused by central venous catheter in two newborns. Rev Bras Cir Cardiovasc. 2008;23:422–4.CrossRefPubMedGoogle Scholar
  59. 59.
    Shenoy R. Cardiac tamponade following central line in premature neonate: case report and review of the literature. Internet J Pediatr Neonatol. 2008;10:10207.Google Scholar
  60. 60.
    Towbin R. The bowed catheter sign: a risk for pericardial tamponade. Pediatr Radiol. 2008;38:331–5.CrossRefPubMedGoogle Scholar
  61. 61.
    Arya SO, Hiremath GM, Okonkwo KC, Pettersen MD. Central venous catheter-associated pericardial tamponade in a 6-day-old: a case report. Int J Pediatr. 2009;2009:910208.PubMedCentralCrossRefPubMedGoogle Scholar
  62. 62.
    Haass C, Sorrentino E, Tempera A, Consigli C, De Paola D, Calcagni G, Piastra M, Finocchi M. Cardiac tamponade and bilateral pleural effusion in a very low birth weight infant. J Matern Fetal Neonatal Med. 2009;22:137–9.CrossRefPubMedGoogle Scholar
  63. 63.
    Schlapbach LJ, Pfammatter JP, Nelle M, McDougall FJ. Cardiomegaly in a premature neonate after venous umbilical catheterization. Eur J Pediatr. 2009;168:107–9.CrossRefPubMedGoogle Scholar
  64. 64.
    Alabsi S. Neonatal cardiac tamponade and pleural effusion resolved with chest tube placement. Neonatal Netw. 2010;29:347–51.CrossRefPubMedGoogle Scholar
  65. 65.
    Pizzuti A, Parodi E, Abbondi P, Frigerio M. Cardiac tamponade and successful pericardiocentesis in an extremely low birth weight neonate with percutaneously inserted central venous line: a case report. Cases J. 2010;3:15.PubMedCentralCrossRefPubMedGoogle Scholar
  66. 66.
    Thomson TL, Levine M, Muraskas JK, El-Zein C. Pericardial effusion in a preterm infant resulting from umbilical venous catheter placement. Pediatr Cardiol. 2010;31:287–90.CrossRefPubMedGoogle Scholar
  67. 67.
    Megha M, Jain N, Pillai R. Pericardial tamponade in a newborn following umbilical catheter insertion. Indian Pediatr. 2011;48:404–5.PubMedGoogle Scholar
  68. 68.
    Abdellatif M, Ahmed A, Alsenaidi K. Cardiac tamponade due to umbilical venous catheter in the newborn. BMJ Case Rep. 2012;13:2012.Google Scholar
  69. 69.
    Farry PM, Paterson A. Perforation into the pericardial sac of an infant: a rare complication of central venous catheter insertion. Ulster Med J. 2012;81:50–1.PubMedCentralPubMedGoogle Scholar
  70. 70.
    Daud DF, de Campos MMF, de Pádua Fleury Campos Neto LA. Cardiac tamponade in an infant during contrast infusion through central venous catheter for chest computed tomography. Radiol Bras. 2013;46:385–6.CrossRefGoogle Scholar
  71. 71.
    Kumar N, Murki S. Bilateral pleural effusion complicating umbilical venous catheterization. Indian Pediatr. 2013;50:1157–8.CrossRefPubMedGoogle Scholar
  72. 72.
    Rajpal MN, Buechler LS, Rao R. Chylous cardiac tamponade due to catheter-associated thrombosis of intrathoracic veins in a newborn infant. J Pediatr Surg Case Rep. 2013;1:180–2.CrossRefGoogle Scholar
  73. 73.
    Ozturk E, Tanidir IC, Saygi M, Ergul Y, Guzeltas A, Odemis E. Evaluation of non-surgical causes of cardiac tamponade in children at a cardiac surgery center. Pediatr Int. 2014;56:13–8.CrossRefPubMedGoogle Scholar
  74. 74.
    Dos Santos Modelli ME. Cavalcanti FB. Fatal cardiac tamponade associated with central venous catheter: a report of 2 cases diagnosed in autopsy. Am J Forensic Med Pathol. 2014;35:26–8.CrossRefPubMedGoogle Scholar
  75. 75.
    Bagwell CE, Salzberg AM, Sonnino RE, Haynes JH. Potentially lethal complications of central venous catheter placement. J Pediatr Surg. 2000;35:709–13.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2015

Authors and Affiliations

  1. 1.Department of AnesthesiaJapan Community Health Care Organization, Kyushu HospitalKitakyushuJapan

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