Pediatric Sudden Cardiac Arrest

Abstract

Pediatric sudden cardiac arrest (SCA), which can cause sudden cardiac death if not treated within minutes, has a profound effect on everyone: children, parents, family members, communities, and health care providers. Preventing the tragedy of pediatric SCA, defined as the abrupt and unexpected loss of heart function, remains a concern to all. The goal of this statement is to increase the knowledge of pediatricians (including primary care providers and specialists) of the incidence of pediatric SCA, the spectrum of causes of pediatric SCA, disease-specific presentations, the role of patient and family screening, the rapidly evolving role of genetic testing, and finally, important aspects of secondary SCA prevention. This statement is not intended to address sudden infant death syndrome or sudden unexplained death syndrome, nor will specific treatment of individual cardiac conditions be discussed. This statement has been endorsed by the American College of Cardiology, the American Heart Association, and the Heart Rhythm Society.

Sudden Unexplained Cardiac Arrest in Apparently Healthy Children: A Single-Center Experience

“…These 3 diseases would have most likely been able to be diagnosed by a pre-event EKG. The stimulant medication with prevalence of use in 2%–18% of the children in the general population [21], has central and peripheral catecholaminergic effects and has been documented in the literature as a possible contributor of acute mortality in children [3, 20, 22–24]; however, one very large study has shown an elevated but statistically non-significant hazard ratio of SCA [25]. Stimulant use and abuse can lead to a statistically significant increase in heart rate [26, 27], blood pressure [26, 27] and cardiomyopathies, all increasing the risk for arrhythmias and sudden cardiac arrest [24].…”

“…A recent metanalysis has shown that an EKG has high sensitivity for mass screening in asymptomatic children with detectable causes of SCA such as hypertrophic cardiomyopathy, LQTS and WPW [29]. Current recommendations by American Academy of Pediatrics [3, 30, 31], FDA’s Pediatric Advisory Committee [32] and American Academy of Child and Adolescent Psychiatry [33] do not include an EKG for screening a child prior to starting stimulants for ADHD or participation in sports. The American Heart Association recommends that obtaining an EKG prior to starting the stimulants a reasonable option and further recommends a cardiology consult if there are any red-flags on history, physical examination or the EKG [34].…”

“…Currently recommended screening Questionnaires [3, 4] are incomplete in some of this important data.…”

“…Over the last decade there has been increased focus on primary preventive strategies [3] such as (a) screening Questionnaire[4, 5] with utilization of disqualification criteria for participation in physical education and sports, (b) EKG and other investigations; and secondary preventive strategies [3] (a) automated external defibrillator (AED) [6] and (b) automated implantable cardioverter defibrillators (AICD) [7]. Although a screening Questionnaire is currently used for primary prevention of SCA, there is controversy regarding the use of additional testing such as a screening EKG.…”

Sudden unexpected cardio-respiratory arrest after venipuncture in children

“…No screening protocol has yet proven to be effective in this role or validated as highly effective. 23) …”