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Cardiovascular Collapse with Intravenous Amiodarone in Children: A Multi-Center Retrospective Cohort Study
Khadijah Maghrabi1, Orhan Uzun2, Joel A Kirsh3,4
1Department of Pediatrics, Abdullah Bakhsh Children's Heart Center, King Abdulaziz University, PO Box 80215, Jeddah, 21589, Saudi Arabia. kamaghrabi@kau.edu.sa.
Insights
Intravenous amiodarone can cause cardiovascular collapse in 10% of pediatric patients. Risk factors include young age, low blood pressure, and rapid bolus administration, necessitating careful monitoring.
Area of Science:
- Pediatric Cardiology
- Clinical Pharmacology
Background:
- Intravenous amiodarone is used for pediatric arrhythmias.
- Cardiovascular collapse is a serious adverse event associated with its use.
Purpose of the Study:
- To determine the incidence of cardiovascular collapse in children receiving IV amiodarone.
- To identify patient and administration-related risk factors for this adverse event.
Main Methods:
- Multicenter retrospective analysis of 456 pediatric patients (≤18 years) who received IV amiodarone from 2005-2015.
- Identification of cardiovascular collapse (bradycardia and/or hypotension) as the primary outcome.
- Univariate and multivariate analyses to identify risk factors.
Main Results:
- Cardiovascular collapse occurred in 10% (47/456) of patients.
- Independent risk factors for collapse included younger age (<3 months), baseline blood pressure below the 3rd percentile, and rapid bolus administration (≤20 minutes).
- Mortality was significantly higher in the collapse group (28% vs. 8%).
Conclusions:
- IV amiodarone administration is associated with a significant risk of cardiovascular collapse in pediatric patients.
- Close hemodynamic monitoring is crucial, particularly in infants, hemodynamically compromised children, and those receiving rapid bolus infusions.
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.
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