Systematic review of the treatment options for pericardial effusions in dogs

Objective: To evaluate the evidence for the conservative and surgical management of pericardial effusions for neoplastic and idiopathic etiologies in dogs. Study design: Systematic review. Sample population: Peer-reviewed English-language articles describing the treatment and outcome of naturally occurring pericardial effusion in domestic dogs. Methods: A literature search was performed with PubMed, Cab Abstracts, Scopus, and Agricola in August 2019 for articles describing pericardial effusion treatment in dogs. Inclusion criteria were applied, and articles were evaluated for reported outcome and level of evidence by using The Oxford 2011 Levels of Evidence, a previously described hierarchical system, and GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Results: One hundred eight of the 641 unique articles that were identified and evaluated met inclusion criteria. Most articles included were case studies (68.2%) or retrospective case series (25.2%), with all articles providing a low level of evidence. The articles had inconsistent inclusion criteria, outcome measures, and follow-up, making comparison of outcomes difficult. Conclusion: Because of the low quality of evidence of the studies included in this systematic review and the variability of the outcomes, there is not sufficient evidence to recommend one treatment option rather than another. Clinical significance: There is a requirement for higher quality evidence such as randomized controlled trials and prospective comparative cohort studies. Standardization of outcome measures reported for each treatment option and disease process studied will allow for better comparison of outcomes between studies.