UMEM Educational Pearls

Category: Critical Care

Title: Fluid boluses don't always work....

Keywords: pericardial tampaonde, shock, tamponade, fluids, hypoperfusion (PubMed Search)

Posted: 2/13/2012 by Haney Mallemat, MD (Emailed: 2/14/2012) (Updated: 2/15/2012)
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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.


Sagrista-Sauleda, et al. Hemodynamic effects of volume expansion in patients with cardiac tamponade. Circulation 2008; 117:1545

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