Pericardial Tamponade in Trauma: A Systematic Review of Diagnosis, Emergency Management, and Surgical Outcomes

Traumatic pericardial tamponade is a life-threatening emergency caused by the rapid accumulation of blood in the pericardial sac, leading to cardiac compression, decreased cardiac output, and obstructive shock. Early recognition and prompt intervention are crucial in preventing cardiovascular collapse. However, timely diagnosis remains challenging due to overlapping injuries and non-specific clinical signs in trauma settings. This systematic review aimed to evaluate the diagnostic approaches, emergency management strategies, and surgical outcomes associated with pericardial tamponade in trauma patients. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science for studies published between 2000 and 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting on diagnosis, emergency interventions, and surgical outcomes in traumatic pericardial tamponade were included. Five studies involving a total of 546 patients met the inclusion criteria. Data extraction and quality assessment were independently conducted by two reviewers using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. The majority of cases resulted from penetrating chest trauma. Focused assessment with sonography for trauma (FAST) proved to be the most effective tool for early diagnosis, significantly improving detection rates in emergency settings. Pericardiocentesis (PCC) was primarily used as a temporizing measure, while definitive management commonly involved surgical intervention, most notably thoracotomy or pericardial window. Early surgical intervention, especially within the first hour post-injury, was associated with significantly improved survival outcomes. Traumatic pericardial tamponade is a time-critical surgical emergency where rapid diagnosis and early operative management are vital. While PCC may serve as a bridge in select scenarios, definitive surgical treatment remains the gold standard. Multicenter prospective studies are needed to establish standardized protocols and improve outcomes across various healthcare settings.