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

Abstract

Objective To determine the causes of sudden cardiac arrest (SCA) in apparently healthy children in a single center in the era of primary prevention (screening questionnaire, SQ) and secondary prevention (automated external defibrillator, AED and automated implantable cardioverter defibrillator, AICD). Study Design Any child (0–18 year’s age) without prior known disease except for attention deficit disorder who underwent out-of-the hospital cardiopulmonary resuscitation was included in the study as SCA. Using retrospective chart review we evaluated the efficacy of the SQ, electrocardiogram (EKG), chest roentgenogram (CXR) and an echocardiogram. Results We found 44 out of 6,656 children admitted to intensive care with SCA; an AED was used in 39%, AICD placed in 18% and survival to hospital discharge was 50%. The etiology for SCA was identified in 57% of the cases, mostly in those above one year of age and among these the majority of had a cardiac etiology (50%) while 7% had rupture of an arteriovenous malformation. Stimulant medication use was seen in 11% of the SCA. In the best case scenario of hypothesized primary prevention, a prior SQ, CXR, EKG and echocardiogram may have detected 18%, 9%, 23% and 16% of at-risk cases respectively and 32% may have been detected with EKG and SQ together. Based on a historical control cohort, a positive EKG was significantly higher in children with SCA (p = 0.014). Conclusion An EKG along with a screening SQ may be more effective in identifying children who are potentially at-risk for SCA than a SQ alone.

AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current evidence, knowledge gaps, recommendations and future directions

“…The addition of a screening ECG to the history and physical examination increases the detection of cardiac disorders potentially at risk of SCA/D in athletes 39–41 54 68 70 72 83. An estimated 60% of the disorders associated with SCA/D in young individuals may have detectable ECG abnormalities 17.…”

Vaccination and 30-Day Mortality Risk in Children, Adolescents, and Young Adults

“…Sudden deaths such as this, although uncommon, do occur in this population, regardless of vaccination history. [36][37][38] VAERS monitors the safety of all vaccinations, including 4vHPV. 39 From June 2006 to March 2013, 96 reports of death after receipt of 4vHPV vaccine were submitted to VAERS.…”

Sudden unexpected cardio-respiratory arrest after venipuncture in children

“…21) In one single center study, the etiology for sudden cardiac arrest was identified in 57% of the cases, mostly in those above 1 year of age and among these the majority of had a cardiac etiology (50%) while 7% had rupture of an arteriovenous malformation. 12) Acute myocarditis is a disease with a variable natural history and is difficult to diagnose. Often, the symptoms of acute myocarditis are initially flu like, either of the upper respiratory or gastrointestinal tract, before any cardiac symptoms appear.…”

“… 11) Cardiac causes were most common, but an etiology was less evident in infants in comparison to older children. 12) Although the definite causes have not been identified, vasovagal reaction has been suggested as a cause of cardiac arrest following venipuncture, resulting in serious cardiac dysfunction, such as asystole.…”