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Pericardiocentesis may be indicated during resuscitation for pulseless electrical activity (PEA). If the PEA is the result of cardiac tamponade, pericardiocentesis may reverse that condition. Cardiac tamponade may be difficult to diagnose in the out‐of‐hospital setting. Tamponade may be suspected based on the patient’s clinical presentation. Prior to cardiac arrest, the patient may develop Beck’s triad of jugular venous distension, hypotension, and muffled heart sounds. If available, portable ultrasound can be used to detect tamponade.

Successful pericardiocentesis has been performed in the out‐of‐hospital setting by both EMS physicians and critical care transport teams [30, 31]. It should be used as a final resort when all other therapies have failed [32]. For procedure details, see Chapter 40. Aspiration of blood that does not clot suggests removal from the pericardial space, as opposed to intraventricular blood. Successful pericardiocentesis and the correction of the tamponade physiology should lead to restoration of spontaneous circulation.