Introduction to Pediatric Crises

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.

scholarly journals Discovery of predictors of sudden cardiac arrest in diabetes: rationale and outline of the RESCUED (REcognition of Sudden Cardiac arrest vUlnErability in Diabetes) project

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001554
Author(s):  
Laura H van Dongen ◽  
Peter P Harms ◽  
Mark Hoogendoorn ◽  
Dominic S Zimmerman ◽  
Elisabeth M Lodder ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Prognostic Model ◽  
Early Recognition ◽  
Sudden Cardiac Arrest ◽  
Clinical Genetic ◽  
Innovative Strategy ◽  
Rare Variant Analysis ◽  
Increased Risk ◽  
Gp Care

IntroductionEarly recognition of individuals with increased risk of sudden cardiac arrest (SCA) remains challenging. SCA research so far has used data from cardiologist care, but missed most SCA victims, since they were only in general practitioner (GP) care prior to SCA. Studying individuals with type 2 diabetes (T2D) in GP care may help solve this problem, as they have increased risk for SCA, and rich clinical datasets, since they regularly visit their GP for check-up measurements. This information can be further enriched with extensive genetic and metabolic information.AimTo describe the study protocol of the REcognition of Sudden Cardiac arrest vUlnErability in Diabetes (RESCUED) project, which aims at identifying clinical, genetic and metabolic factors contributing to SCA risk in individuals with T2D, and to develop a prognostic model for the risk of SCA.MethodsThe RESCUED project combines data from dedicated SCA and T2D cohorts, and GP data, from the same region in the Netherlands. Clinical data, genetic data (common and rare variant analysis) and metabolic data (metabolomics) will be analysed (using classical analysis techniques and machine learning methods) and combined into a prognostic model for risk of SCA.ConclusionThe RESCUED project is designed to increase our ability at early recognition of elevated SCA risk through an innovative strategy of focusing on GP data and a multidimensional methodology including clinical, genetic and metabolic analyses.

scholarly journals hERG K+ Channels: Structure, Function, and Clinical Significance

2012 ◽  
Vol 92 (3) ◽  
pp. 1393-1478 ◽  
Author(s):  
Jamie I. Vandenberg ◽  
Matthew D. Perry ◽  
Mark J. Perrin ◽  
Stefan A. Mann ◽  
Ying Ke ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Endocrine Cells ◽  
Sudden Cardiac Arrest ◽  
Brain Regions ◽  
Delayed Rectifier ◽  
Prescription Medications ◽  
Tumor Cell Lines ◽  
Drug Induced ◽  
Increased Risk ◽  
Wide Range

The human ether-a-go-go related gene (hERG) encodes the pore-forming subunit of the rapid component of the delayed rectifier K+ channel, Kv11.1, which are expressed in the heart, various brain regions, smooth muscle cells, endocrine cells, and a wide range of tumor cell lines. However, it is the role that Kv11.1 channels play in the heart that has been best characterized, for two main reasons. First, it is the gene product involved in chromosome 7-associated long QT syndrome (LQTS), an inherited disorder associated with a markedly increased risk of ventricular arrhythmias and sudden cardiac death. Second, blockade of Kv11.1, by a wide range of prescription medications, causes drug-induced QT prolongation with an increase in risk of sudden cardiac arrest. In the first part of this review, the properties of Kv11.1 channels, including biogenesis, trafficking, gating, and pharmacology are discussed, while the second part focuses on the pathophysiology of Kv11.1 channels.

scholarly journals Increased Risk of Sudden Cardiac Arrest in Obstructive Pulmonary Disease: A Case-Control Study

PLoS ONE ◽  
2013 ◽  
Vol 8 (6) ◽  
pp. e65638 ◽  
Author(s):  
Miriam Jacoba Warnier ◽  
Marieke Tabo Blom ◽  
Abdennasser Bardai ◽  
Jocelyn Berdowksi ◽  
Patrick Cyriel Souverein ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Pulmonary Disease ◽  
Case Control Study ◽  
Sudden Cardiac Arrest ◽  
Case Control ◽  
Obstructive Pulmonary Disease ◽  
Increased Risk ◽  
Control Study

scholarly journals J wave is associated with increased risk of sudden cardiac arrest in patients with hypertrophic cardiomyopathy

2013 ◽  
Vol 41 (4) ◽  
pp. 1281-1290 ◽  
Author(s):  
Yanbing Li ◽  
Jun Mao ◽  
Qian Yan ◽  
Shuyuan Qi ◽  
Xiaoyan Liu ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hypertrophic Cardiomyopathy ◽  
Sudden Cardiac Arrest ◽  
Increased Risk ◽  
J Wave

Clinical Presentation of Pediatric Patients at Risk for Sudden Cardiac Arrest

2016 ◽  
Vol 177 ◽  
pp. 191-196 ◽  
Author(s):  
Aarti Dalal ◽  
Richard J. Czosek ◽  
Joshua Kovach ◽  
Johannes C. von Alvensleben ◽  
Santiago Valdes ◽  
...  
Keyword(s):  
At Risk ◽  
Cardiac Arrest ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Sudden Cardiac Arrest ◽  
Patients At Risk

scholarly journals Cardiac Arrests and Deaths Associated with Malignant Hyperthermia in North America from 1987 to 2006

2008 ◽  
Vol 108 (4) ◽  
pp. 603-611 ◽  
Author(s):  
Marilyn Green Larach ◽  
Barbara W. Brandom ◽  
Gregory C. Allen ◽  
Gerald A. Gronert ◽  
Erik B. Lehman
Keyword(s):  
United States ◽  
Cardiac Arrest ◽  
Malignant Hyperthermia ◽  
Odds Ratio ◽  
Anesthetic Management ◽  
The United States ◽  
Exclusion Criterion ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Increased Risk

Background The authors determined associated cardiac arrest and death rates in cases from Canada and the United States as reported to The North American Malignant Hyperthermia (MH) Registry and analyzed factors associated with a higher risk of poor outcomes. Methods The authors searched the database for AMRA (adverse metabolic/musculoskeletal reaction to anesthesia) reports with inclusion criteria as follows: event date between January 1, 1987, and December 31, 2006; "very likely" or "almost certain" MH as ranked by MH Clinical Grading Scale; location in Canada or the United States; and one or more anesthetic agents given. The exclusion criterion was a pathologic condition other than MH independently judged by the authors. Severe MH outcomes were analyzed as regards clinical history and presentation, using Wilcoxon rank sum tests for continuous variables and Pearson exact chi-square tests for categorical variables. A Bonferroni correction adjusted for multiple comparisons. Results Of 291 events, 8 (2.7%) resulted in cardiac arrests and 4 (1.4%) resulted in death. The median age in cases of cardiac arrest/death was 20 yr (range, 2-31 yr). Associated factors were muscular build (odds ratio, 18.7; P = 0.0016) and disseminated intravascular coagulation (odds ratio, 49.7; P < 0.0001). Increased risk of cardiac arrest/death was related to a longer time period between anesthetic induction and maximum end-tidal carbon dioxide (216 vs. 87 min; P = 0.003). Unrelated factors included patient or family history, anesthetic management, and the MH episode. Conclusions Modern US anesthetic practice did not prevent MH-associated cardiac arrest and death in predominantly young, healthy patients undergoing low- to intermediate-risk surgical procedures.

scholarly journals Outcomes of Pediatric Patients with Defibrillators Following Initial Presentation with Sudden Cardiac Arrest

2021 ◽  
Author(s):  
Jeffrey A. Robinson ◽  
Martin J. LaPage ◽  
Joseph Atallah ◽  
Gregory Webster ◽  
Christina Y. Miyake ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Pediatric Patients ◽  
Sudden Cardiac Arrest ◽  
Underlying Disease ◽  
Secondary Prophylaxis ◽  
Implantable Cardioverter Defibrillators ◽  
Degree Relative ◽  
Appropriate Shocks ◽  
History Of

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.

Abstract 16917: The Forgotten Prolapsed Mitral Valve in a Patient With Sudden Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mark W Vanderland ◽  
YinnShaung Ooi ◽  
Muhammad Shakir ◽  
Douglas Esberg
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Mitral Valve ◽  
Coronary Angiography ◽  
Cardiac Mri ◽  
Sinus Bradycardia ◽  
Sudden Cardiac Arrest ◽  
Mri Findings ◽  
True Incidence ◽  
Increased Risk

Current literature suggests that the incidence of sudden cardiac arrest (SCA) attributable to mitral valve prolapse (MVP) is more common than historically presumed. Although its true incidence remains unknown, this novel realization suggests that the presence of MVP after resuscitated SCA should prompt exploratory identification of a causative association between MVP and SCA, even in the presence of other plausible explanatory findings. Case Description: A 60-year-old male with a history of hypertension presented with an out-of-hospital cardiac arrest due to ventricular fibrillation (VF). Coronary angiography revealed a 99% occluded 1st diagonal branch which was stented. TTE showed normal biventricular function and coincidentally found a myxomatous mitral valve with bileaflet prolapse. The patient was discharged without further work up under the rationale that the ischemic etiology of his arrest was reversed. 6 months later, he presented with another episode of VF arrest. EKG showed sinus bradycardia and a QTc of 534ms. Troponin was negative. Coronary angiography revealed a patent stent and coronary vessels. A cardiac MRI was obtained to investigate the arrhythmic significance of his MVP and showed late gadolinium enhancement in the basal inferolateral wall and tips of the mitral papillary muscles. A dual chamber implantable cardiac defibrillator was placed with a plan for future mitral valve repair. Discussion: Recent studies suggest that the estimated annual risk of SCA due to MVP is 0.2% to 1.9%, a figure higher than previously reported. Certain EKG, TTE and cardiac MRI findings have been associated with an increased risk of ventricular arrhythmias and SCA. In this patient, this included bileaflet MVP, mitral antral disjunction, and inferobasal wall and papillary muscle fibrosis. Currently, there are no society guidelines to assist in the identification of patients with MVP at high-risk for SCA. Nonetheless, in patients with MVP resuscitated from SCA, further workup to identify high risk features is reasonably justified to guide secondary SCA prophylaxis, even in the presence of other explanatory findings for SCA.

Analysis of Unplanned Intensive Care Unit Admissions in Postoperative Pediatric Patients

2016 ◽  
Vol 32 (3) ◽  
pp. 204-211 ◽  
Author(s):  
Elizabeth K. Landry ◽  
Rodney A. Gabriel ◽  
Sascha Beutler ◽  
Richard P. Dutton ◽  
Richard D. Urman
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Multivariate Logistic Regression Analysis ◽  
Data Set ◽  
Icu Admission ◽  
Increased Risk ◽  
Wide Range

Background: Currently, there are only a few retrospective, single-institution studies that have addressed the prevalence and risk factors associated with unplanned admissions to the pediatric intensive care unit (ICU) after surgery. Based on the limited amount of studies, it appears that airway and respiratory complications put a child at increased risk for unplanned ICU admission. A more extensive and diverse analysis of unplanned postoperative admissions to the ICU is needed to address risk factors that have yet to be revealed by the current literature. Aim: To establish a rate of unplanned postoperative ICU admissions in pediatric patients using a large, multi-institution data set and to further characterize the associated risk factors. Methods: Data from the National Anesthesia Clinical Outcomes Registry were analyzed. We recorded the overall risk of unplanned postoperative ICU admission in patients younger than 18 years and performed univariate and multivariate logistic regression analysis to identify the associated patient, surgical, and anesthetic-related characteristics. Results: Of the 324 818 cases analyzed, 211 reported an unexpected ICU admission. There was an increased likelihood of unplanned postoperative ICU in infants (age <1 year) and children who were classified as American Society of Anesthesiologists physical status classification of III or IV. Likewise, longer case duration and cases requiring general anesthesia were also associated with unplanned ICU admissions. Conclusion: This study establishes a rate of unplanned ICU admission following surgery in the heterogeneous pediatric population. This is the first study to utilize such a large data set encompassing a wide range of practice environments to identify risk factors leading to unplanned postoperative ICU admissions. Our study revealed that patient, surgical, and anesthetic complexity each contributed to an increased number of unplanned ICU admissions in the pediatric population.

Clinical outcomes in adult athletes with hypertrophic cardiomyopathy: a 7-year follow-up study

2020 ◽  
Vol 54 (16) ◽  
pp. 1008-1012 ◽  
Author(s):  
Antonio Pelliccia ◽  
Stefano Caselli ◽  
Matteo Pelliccia ◽  
Maria Beatrice Musumeci ◽  
Erika Lemme ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hypertrophic Cardiomyopathy ◽  
Sport Participation ◽  
Sudden Cardiac Arrest ◽  
Left Ventricular ◽  
Rank Test ◽  
Competitive Sport ◽  
Increased Risk ◽  
Exercise Programmes

ObjectiveCurrent guidelines recommend precautionary disqualification from competitive sports in patients with hypertrophic cardiomyopathy (HCM). We assessed the incidence of cardiovascular events in a cohort of patients with HCM engaged in long-term exercise programmes and competitive sport.MethodsWe reviewed data on 88 consecutive athletes diagnosed with HCM, from 1997 to 2017; 92% male, 98% Caucasian, median age 31 (IQR: 19–44) years. All participated in regular exercise programmes and competitive sport at study entry.We performed follow-up evaluation after 7±5 (1–21) years. 61 (69%) of the athletes had substantially reduced or stopped exercise and sport (ie, HCM-detrained), and 27 had continued with regular training and sport competitions (HCM-trained). At baseline evaluation, both groups were similar for age, gender balance, symptoms, ECG abnormalities, extent of left ventricular hypertrophy, arrhythmias and risk profile for sudden cardiac death/arrest.ResultsDuring the follow-up period, two participants suffered sudden cardiac arrest or death (0.3% per year) both outside of sport participation. In addition, 19 (22%) reported symptoms (syncope in 3, palpitations in 10, chest pain in 4 and dyspnoea in 2). The Kaplan-Meier analyses of freedom from combined sudden cardiac arrest/death and symptoms (log-rank test p=0.264) showed no differences between HCM-trained and detrained patients.ConclusionIn this adult cohort of low-risk HCM athletes, voluntary decision to pursue in participation in competitive sport events was not associated with increased risk for major cardiac events or clinical worsening compared with decision to reduce or withdraw from exercise programmes and sport. Similar results may not be seen in younger or racially diverse athlete populations, or in patients with more severe HCM phenotypes.

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