The Advanced Trauma Life Support (ATLS®) course highlights pericardiocentesis as one of the therapeutic options for pericardial tamponade from cardiac injuries [1]. While thoracotomy or median sternotomy followed by cardiorrhaphy remains the gold standard treatment for penetrating cardiac rupture [2], pericardiocentesis continues to be taught in the ATLS® course as a bridge to definitive surgery [3]. However, there is limited evidence supporting emergent pericardiocentesis as an effective method to decompression of traumatic pericardial tamponade, with existing evidence favoring survivors and lacking robust outcome data [3,4].

A major concern regarding the reliability of pericardiocentesis in traumatic pericardial tamponade is the high false-negative rate, which can delay definitive surgical interventions [3,5,6]. Since definitive treatment for traumatic tamponade is always surgery, a negative pericardiocentesis does not rule out a significant injury [2,6]. In penetrating cardiac trauma, substantial data have consistently demonstrated that early thoracotomy or sternotomy improves survival rates [3]. This distinction can be even more difficult to assess in blunt trauma patients, as the presence of pericardial fluid does not always indicate a life-threatening cardiac injury [7]. Patients may present with chronic pericardial effusion, post-traumatic effusion, or hemopericardium, which can range from self-limiting to indicative of a serious cardiac injury [7]. Consequently, in the setting of blunt trauma, pericardiocentesis is generally reserved for hypotensive patients or those with other concerning clinical signs, and may serve both diagnostic and therapeutic functions [7].

Between 1970 and 2010, pericardiocentesis utilization in trauma declined significantly, while thoracotomy without pericardiocentesis increased [3]. Since then, research on pericardiocentesis for traumatic pericardial tamponade has been limited, leaving critical knowledge gaps regarding recent practice changes and indications for pericardiocentesis. While still included in the ATLS® course curriculum, the current role of pericardiocentesis remains unclear and warrants further investigation. This study aims to characterize contemporary practice patterns and national trends in emergency pericardiocentesis for trauma, with a focus on differences between penetrating and blunt mechanisms.