Supraventricular Tachycardia Without Preexcitation as a Cause of Sudden Cardiac Arrest in Pediatric Patients

Background - Implantable cardioverter defibrillators (ICD) are recommended for secondary prevention after sudden cardiac arrest (SCA). The outcomes of pediatric patients receiving an ICD after SCA remain unclear. The objective of this study is to evaluateoutcomes, future risk for appropriate shocks, and identify characteristics associated with appropriate ICD therapy during follow-up. Methods - Multi-center retrospective analysis of patients (≤21 yrs) without prior cardiac disease who received an ICD following SCA. Patient/device characteristics, cardiac function, and underlying diagnoses were collected, along with SCA event characteristics. Patient outcomes including complications and device therapies were analyzed. Results - In total, 106 patients were included, median age 14.7 yrs. Twenty (19%) received appropriate shocks and 16 (15%) received inappropriate shocks (median follow up 3 yrs). First-degree relative with SCA was associated with appropriate shocks (p<0.05). In total, 40% patients were considered idiopathic. Channelopathy was the most frequent late diagnosis not made at time of presentation. Neither underlying diagnosis nor idiopathic status was associated with increased incidence of appropriate shock. Monomorphic ventricular tachycardia (HR 4.6 [1.2; 17.3]) and family history of sudden death (HR 6.5 [1.4;29.8]) were associated with freedom from appropriate shock in a multivariable model (AUC=0.8). Time from diagnoses to evaluation demonstrated a non-linear association with freedom from appropriate shock (p=0.015). In patients >2 yrs from implantation, younger age (p=0.02) and positive exercise test (p=0.04) were associated with appropriate shock. Conclusions - The risk of future device therapy is high in pediatric patients receiving an ICD after SCA, irrelevant of underlying disease. Lack of a definitive diagnosis after SCA was not associated with lower risk of subsequent events and does not obviate the need for secondary prophylaxis.

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The dentist’ attitude towards obtaining the intreaosseus access during sudden cardiac arrest in pediatric patients

Resuscitation ◽

10.1016/j.resuscitation.2018.07.251 ◽

2018 ◽

Vol 130 ◽

pp. e119

Author(s):

Jacek Smereka ◽

Wojciech Wieczorek ◽

Jerzy Ladny ◽

Wladyslaw Gawel ◽

Kurt Ruetzler ◽

...

Keyword(s):

Cardiac Arrest ◽

Pediatric Patients ◽

Sudden Cardiac Arrest

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Introduction to Pediatric Crises

10.1093/med/9780190226459.003.0076 ◽

2017 ◽

Author(s):

Scott C. Watkins

Keyword(s):

Cardiac Arrest ◽

Malignant Hyperthermia ◽

Pediatric Patients ◽

Surgical Intervention ◽

Sudden Cardiac Arrest ◽

Pulmonary Diseases ◽

Muscular Dystrophies ◽

Increased Risk ◽

Wide Range ◽

Pierre Robin

Clinicians caring for pediatric patients must be prepared to manage the wide range of physiological norms and diverse pathological states that children may pose when presenting for anesthesia and surgery. Anesthesiologists caring for children should be familiar with syndromes and diseases that pose increased risk for difficult airway (e.g., Treacher-Collins, Pierre-Robin), malignant hyperthermia (e.g., King Denborough, central core disease), hyperkalemia (e.g., muscular dystrophies, periodic hyperkalemic paralysis), and sudden cardiac arrest (e.g., William’s, Pompe, myocarditis/cardiomyopathy). However, these diseases and syndromes are relatively rare, and the majority of challenging pediatric patients will not carry a named syndrome. Some of the more challenging cases an anesthesiologist may face include the child presenting emergently for surgery, neonates needing surgical intervention, and children with severe comorbidities including cardiac and pulmonary diseases. This section is dedicated to the pediatric patient and the unique challenges these patients pose to those tasked with caring for them.

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