The incidence of echocardiographically determined pericardial effusion was assessed in the early postmanual cardiopulmonary resuscitation (CPR) period in a group of patients resuscitated by advanced emergency medical technicians (EMT-P) from the Rescue Division of the Tampa Fire Department. The survival rate from out-of-hospital sudden death is comparable to that reported in other series. Twenty-six survivors of out-of-hospital sudden death had echocardiograms performed an average of 2.5 days (range 0-10) postCPR to determine the amount of pericardial effusion. Eight of the 26 (31%) patients had received intracardiac drugs during CPR administered by the EMT-Ps when physician-directed by radio. Of the 26, three (12%) were found to have very minimal pericardial effusions; all deemed insignificant. All three had alternate explanations for physiological or pathological causes of their effusions. One had received intracardiac drugs, but the pericardial effusion could be explained by congestive cardiomyopathy. Another had congestive cardiomyopathy, and the third had sustained a severe steering wheel injury to the chest. Thus, manual CPR with or without the use of intracardiac drugs does not appear to cause significant pericardial effusions in survivors of sudden cardiac death.