Little is known about the predictors of pre-emergency medical service (EMS) automated external defibrillator (AED) application in pediatric out-of-hospital cardiac arrests. We sought to determine patient- and neighborhood-level characteristics associated with pre-EMS AED application in the pediatric population.We reviewed prospectively collected data from the Cardiac Arrest Registry to Enhance Survival on pediatric patients (age >1 to ≤18 years old) who had out-of-hospital nontraumatic arrest (2013-2015).A total of 1398 patients were included in this analysis (64% boys, 45% white, and median age of 11 years old). An AED was applied in 28% of the cases. Factors associated with pre-EMS AED application in univariable analyses were older age (odds ratio [OR]: 1.9; 12-18 years old vs 2-11 years old; P < .001), white versus African American race (OR: 1.4; P = .04), public location (OR: 1.9; P < .001), witnessed status (OR: 1.6; P < .001), arrests presumed to be cardiac versus respiratory etiology (OR: 1.5; P = .02) or drowning etiology (OR: 2.0; P < .001), white-populated neighborhoods (OR: 1.2 per 20% increase in white race; P = .01), neighborhood median household income (OR: 1.1 per $20 000 increase; P = .02), and neighborhood level of education (OR: 1.3 per 20% increase in high school graduates; P = .006). However, only age, witnessed status, arrest location, and arrests of presumed cardiac etiology versus drowning remained significant in the multivariable model. The overall cohort survival to hospital discharge was 19%.The overall pre-EMS AED application rate in pediatric patients remains low.
Introduction: Heart failure represents 10-33% of pediatric cardiac admissions. We present diagnostic challenges of LCOS in an adolescent patient with pre-existent severe heart failure. Description: A 15-year-old female with non-obstructive hypertrophic cardiomyopathy and severe left ventricular dysfunction presented with 2 days of vomiting, and worsening somnolence. Her past history included Danon disease, non-sustained ventricular tachycardia s/p implantable cardiac defibrillator placement, type 1 diabetes mellitus, remote cerebrovascular infarct, and cognitive impairment. Home medications included carvedilol, lisinopril, verapamil, furosemide, insulin, warfarin and aspirin. Her examination revealed sinus bradycardia (HR: 55-58/min), hypotension (BP: 88/54 mmHg), and profound somnolence. Her laboratory studies revealed lactic acidosis, hyperkalemia without ketoacidosis, and normal glucose levels. She was treated with calcium gluconate, insulin and dextrose, fluid bolus with resolution of her hyperkalemia. Her ECG revealed sinus bradycardia with prolonged PR interval, and her echocardiogram demonstrated severe left ventricular dysfunction. A tentative diagnosis of acute on chronic heart failure was made. Epinephrine infusion (titrated up to 0.2 mcg/kg/min), milrinone infusion, and mechanical ventilation were initiated without response. A suspicion of beta-blocker (BB) and calcium channel blocker (CCB) overdose was entertained for refractory bradycardia and hypotension. A bolus of glucagon followed by infusion, insulin drip and glucose infusion were administered with resolution of her bradycardia and hypotension (HR: 90-114/min; BP: 114/64 mmHg). She was weaned off inotropic support and extubated after 3 days. Discussion: Our case demonstrates diagnostic dilemma of patients presenting in LCOS in the context of pre-existing cardiac dysfunction. A lack of significant improvement on standard therapy should trigger a work-up for additional causes for LCOS. Hospital admissions for intentional overdose have doubled with the sharpest increases observed in adolescent age group. Treatment of BB and CCB overdose is similar, with high-dose insulin and dextrose infusions in addition to catecholamine infusion. Glucagon is utilized to treat refractory bradycardia.
Previous estimates of sudden cardiac death in children and young adults vary significantly, and population-based studies in the United States are lacking. We sought to estimate the incidence, causes, and mortality trends of sudden cardiac death in children and young adults (1-34 years).Demographic and mortality data based on death certificates for US residents (1-34 years) were obtained (1999-2015). Cases of sudden death and sudden cardiac death were retrieved by using the International Classification of Diseases, 10th Revision codes.A total of 1 452 808 subjects aged 1 to 34 years died in the United States, of which 31 492 (2%) were due to sudden cardiac death. The estimated incidence of sudden cardiac death is 1.32 per 100 000 individuals and increased with age from 0.49 (1-10 years) to 2.76 (26-34 years). During the study period, incidence of sudden cardiac death declined from 1.48 to 1.13 per 100 000 (P < .001). Mortality reduction was observed across all racial and ethnic groups with a varying magnitude and was highest in children aged 11 to 18 years. Significant disparities were found, with non-Hispanic African American individuals and individuals aged 26 to 34 years having the highest mortality rates. The majority of young children (1-10 years) died of congenital heart disease (n = 1525, 46%), whereas young adults died most commonly from ischemic heart disease (n = 5075, 29%).Out-of-hospital sudden cardiac death rates declined 24% from 1999 to 2015. Disparities in mortality exist across age groups and racial and ethnic groups, with non-Hispanic African American individuals having the highest mortality rates.
A young child presented with severe ventricular dysfunction and troponin leak in the setting of coronavirus disease-2019. He developed intermittent, self-resolving, and hemodynamically insignificant episodes of complete heart block that were diagnosed on telemetry and managed conservatively. This report is the first description of coronavirus disease-2019-induced transient complete heart block in a child. (Level of Difficulty: Intermediate.).
