Sudden death caused by cardiac tamponade

Central venous catheters today can be inserted with a remarkable degree of ease due to advances in catheter design and cannulation techniques. This is partly responsible for the increase in the use of this form of venous access. Because of this increase, the occurrence of less well-known complications of central venous cannulation are predicted as illustrated by this report on three infants in whom centrally placed catheters penetrated the pericardial sac, causing tamponade. This complication was associated with the use of one particular type of cannula. The manner in which this described hazard was first detected is highlighted. The realisation that tamponade is not entirely preventable and that the clinical manifestations there of are variable makes the exclusion of a hydropericardium by diagnostic tap an essential step during the resuscitation of any patient who collapses unexpectedly with a central venous catheter in place. The recognition of this fact has altered the poor prognosis previously associated with this complication.