Timing of tracheal intubation in traumatic cardiac tamponade: a word of caution

Resuscitation. 2009 Feb;80(2):272-4. doi: 10.1016/j.resuscitation.2008.09.021. Epub 2008 Dec 6.


Airway, breathing, and circulation are top priorities in any resuscitation. However, in cardiac tamponade, the decision to intubate the trachea and initiate positive pressure ventilation (PPV) should only be taken after consideration of the deleterious haemodynamic effects of positive intrathoracic pressure. We suggest that the threshold for intubation and PPV should be raised in tamponade and that intubation and PPV should, if possible, be timed so that relief of tamponade can immediately follow. In the trauma setting, emergency thoracotomy is the best approach. When intubation is unavoidable because of very low oxygen saturation or cardiac arrest, high ventilatory pressures should be avoided.

Publication types

  • Case Reports

MeSH terms

  • Algorithms
  • Blood Pressure
  • Cardiac Tamponade / etiology
  • Cardiac Tamponade / therapy*
  • Heart Valve Prosthesis
  • Humans
  • Intubation, Intratracheal / methods*
  • Male
  • Middle Aged
  • Pericardiocentesis
  • Positive-Pressure Respiration*
  • Wounds, Stab / complications