**6.4 Treatment**

The treatment of cardiac tamponade is decompression with pericardiocentesis which can be done by percutaneous catheter pericardiocentesis or open surgical drainage with or without a pericardial window or video-assisted thoracoscopic pericardiectomy. Catheter pericardiocentesis under echocardiographic or fluoroscopic guidance is a more rapid and less invasive technique. Surgical pericardiocentesis is usually performed in purulent pericarditis bleeding into the pericardium or when pericardial biopsies and pericardiectomy are needed [2, 77]. A triage system proposed by the ESC Working Group on Myocardial and Pericardial Diseases can be used to guide the timing of the pericardiocentesis in non-emergent cases [80]. Fluid removal and decompression of the pericardial cavity rapidly improve the clinical hemodynamic status. Positive pressure mechanical ventilation should be avoided as it increases the intrathoracic pressure that deteriorates cardiac filling. The use of vasodilators and diuretics that reduce the preload is not recommended in the presence of cardiac tamponade [2].
