Khadijah Maghrabi1, Orhan Uzun2, Joel A Kirsh3,4, Seshadri Balaji5, Nicholas H Von Bergen6, Shubhayan Sanatani7. 1. Department of Pediatrics, Abdullah Bakhsh Children's Heart Center, King Abdulaziz University, PO Box 80215, Jeddah, 21589, Saudi Arabia. kamaghrabi@kau.edu.sa. 2. Department of Paediatric Cardiology, University Hospital Wales, Cardiff, UK. 3. Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. 4. Forensic Services and Coroners Complex, Office of the Chief Coroner for Ontario, Toronto, Canada. 5. Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA. 6. The University of Wisconsin, Madison, WI, USA. 7. Children's Heart Centre, University of British Columbia, Vancouver, BC, Canada.
Abstract
OBJECTIVE: To determine the incidence of cardiovascular collapse in children receiving intravenous (IV) amiodarone and to identify the population at risk. DESIGN: A multicenter study of patients ≤ 18 years of age who received intravenous amiodarone between January 2005 and December 2015. A retrospective analysis was performed to identify patients who developed cardiovascular collapse (bradycardia and/or hypotension). RESULTS: Of 456 patients who received amiodarone, cardiovascular collapse occurred in 47 patients (10%). Patient risk factors for collapse in a univariate analysis were as follows: age < 3 months (p = 0.04), depressed cardiac function (p < 0.001), blood pressure below 3rd percentile (p < 0.001), high lactate at baseline (p < 0.001). Administration risk factors included bolus administration (p = 0.04), and bolus administration over ≤ 20 min (p = 0.04). In multivariate analysis, age, baseline blood pressure less than 3rd percentile, and rapid bolus delivery were independent risk factors for cardiovascular collapse in the study group. The mortality rate was significantly higher in the collapse group (28% versus 8%). CONCLUSION: We found an association between IV amiodarone administration and the risk of developing cardiovascular collapse in a significant subset of children. Extreme caution and careful hemodynamic monitoring is recommended when using IV amiodarone in this population, especially in young infants, hemodynamically compromised patients, and in patients receiving rapid amiodarone bolus administration.
OBJECTIVE: To determine the incidence of cardiovascular collapse in children receiving intravenous (IV) amiodarone and to identify the population at risk. DESIGN: A multicenter study of patients ≤ 18 years of age who received intravenous amiodarone between January 2005 and December 2015. A retrospective analysis was performed to identify patients who developed cardiovascular collapse (bradycardia and/or hypotension). RESULTS: Of 456 patients who received amiodarone, cardiovascular collapse occurred in 47 patients (10%). Patient risk factors for collapse in a univariate analysis were as follows: age < 3 months (p = 0.04), depressed cardiac function (p < 0.001), blood pressure below 3rd percentile (p < 0.001), high lactate at baseline (p < 0.001). Administration risk factors included bolus administration (p = 0.04), and bolus administration over ≤ 20 min (p = 0.04). In multivariate analysis, age, baseline blood pressure less than 3rd percentile, and rapid bolus delivery were independent risk factors for cardiovascular collapse in the study group. The mortality rate was significantly higher in the collapse group (28% versus 8%). CONCLUSION: We found an association between IV amiodarone administration and the risk of developing cardiovascular collapse in a significant subset of children. Extreme caution and careful hemodynamic monitoring is recommended when using IV amiodarone in this population, especially in young infants, hemodynamically compromised patients, and in patients receiving rapid amiodarone bolus administration.
Authors: Lindsey E Malloy-Walton; Nicholas H Von Bergen; Seshadri Balaji; Peter S Fischbach; Jason M Garnreiter; S Yukiko Asaki; Jeffrey P Moak; Luis A Ochoa; Philip M Chang; Hoang H Nguyen; Akash R Patel; Christa Kirk; Ashley K Sherman; Jennifer N Avari Silva; J Philip Saul Journal: J Am Heart Assoc Date: 2022-05-02 Impact factor: 6.106