Case presentation
A 60-year-old man with metastatic adenocarcinoma presented acutely unwell with a 2-day history of worsening dyspnoea. Urgent computed tomography identified a pericardial collection and echocardiography confirmed a large pericardial effusion with features of cardiac tamponade. His electrocardiogram showed sinus tachycardia with heart rate 123 b.p.m., blood pressure 101/58 mmHg.
Emergency pericardiocentesis was recommended but, in view of the patient’s clinical instability, a decision was made to minimize the amount of sedation used and to use virtual reality as a therapy adjunct for anxiolysis. The patient received intravenous midazolam 1 mg and fentanyl 25 μg on the high dependency unit. Pericardiocentesis was performed without complication under echocardiography guidance and with immediate haemodynamic improvement.
The virtual reality content chosen was a 360° video pre-recorded on a local Jersey beach at dawn. The content allows the viewer to look around during as the recording progresses to provide an immersive experience. After he had recovered, the patient described the experience as: ‘Wonderful, I forgot what was happening to me for a while’.
Virtual reality using appropriate immersive content has the ability to improve patient experiences during invasive cardiology procedures such as pacemaker implantation, electrophysiological studies, and cardiac catheterization. Virtual reality should be considered as an alternative or adjunct to intravenous sedation, particularly when the use of sedative drugs could be hazardous.
Panel: Top left- chest computed tomography showing pericardial effusion; top right - virtual reality environment of a Jersey beach; bottom - patient undergoing pericardiocentesis.
Consent: The author/s confirm that written consent for submission and publication of this case report including image(s) and associated text has been obtained from the patient in line with COPE guidance.