A fluid bolus is often the first-line therapy for patients with pericardial tamponade. A fluid bolus, however, may not always improve hemodynamics.
The cardiac index of forty-nine patients with cardiac tamponade was assessed before and after a 500 cc normal saline bolus:
47% increased their cardiac index
22% did not demonstrate a change
31% decreased their cardiac index
Bottom-line: A fluid bolus may a reasonable first choice in a hypotensive patient with tamponade, but remember that fluid boluses may not always work. Attempts at fluid resuscitation should never delay definitive treatment with pericardiocentesis.
References
Sagrista-Sauleda, et al. Hemodynamic effects of volume expansion in patients with cardiac tamponade. Circulation 2008; 117:1545
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