C52-12 When CPR Adds Therapeutic Benefits: Case Study on Vanishing Pericardial Effusion Post-resuscitation

Abstract Introduction/Background Vanishing pericardial effusion (PCE) following cardiopulmonary resuscitation (CPR) highlights the critical importance of echocardiographic guidance during pericardiocentesis (Pc) even in critical situations. This phenomenon suggests that CPR may inadvertently provide therapeutic benefits. Case presentation 64-year-old woman with past medical history of HTN, chronic pancreatitis and PCKD who presented as a transfer with dyspnea. Her TTE revealed a large pericardial effusion with no echocardiographic signs of tamponade. Clinically, the patient did not have pulsus paradoxus, or hypotension. However, she was tachycardic and tachypneic. The patient deteriorated quickly not tolerating BiPAP or non-rebreather mask (NRB) and had a PEA arrest. ACLS protocol was initiated, and ROSC was achieved after 3 minutes. Bedside echocardiography at that time showed resolution of the PCE. PEA was due to hypoxia and concomitant acidosis. Discussion This case underscores the dynamic interplay between CPR and pericardial physiology. The mechanical forces during chest compressions can transiently elevate intrathoracic and pericardial pressures, potentially rupturing the pericardium or creating micro pericardial-pleural fistulas that allow effusion drainage into the pleural cavity. Such iatrogenic decompression mimics the therapeutic effects of pericardiocentesis or surgical pericardial window. Although rare, this finding expands understanding of CPR’s mechanical impact on thoracic structures and highlights the need for echocardiographic reassessment post-resuscitation to evaluate new pleural or pericardial changes. Recognizing this mechanism can prevent unnecessary invasive procedures and improve management in similar emergencies.ConclusionPCE resolution and the development of new pleural effusion post CPR can be attributed to the damage of skeletal structures of the thorax with subsequent trauma to the viscera from the fragments of the bony ribs. Also, pericardial damage without rib fracture could be due to increased pressure in the pericardium consequently pericardial rupture with fluid draining into the pleural space or maybe the presence of micro pericardial-pleural fistulas. Effective CPR with pericardial rupture led to similar therapeutic benefits of pericardiocentesis or pericardial window. Echocardiography guidance for pericardiocentesis (Pc) is crucial, even in code situations involving a known large pericardial effusion (PCE). In this case, the PCE resolved spontaneously following chest compressions, without the need for invasive, blind intervention. This abstract is funded by: None