Intensive Care Interventions Among Children With Toxicologic Exposures to Cardiovascular Medications

Area of Science:

• Toxicology
• Pediatric Critical Care
• Cardiovascular Pharmacology

Background:

• Cardiovascular medications, despite their rarity in pediatric toxicologic exposures, pose significant risks due to potent hemodynamic effects.
• Pediatric intensive care unit (PICU) interventions are infrequently required for toxicologic ingestions, but specific drug classes necessitate careful consideration.

Purpose of the Study:

• To determine the prevalence of PICU interventions in pediatric patients exposed to cardiovascular medications.
• To identify risk factors associated with the need for PICU interventions in this population.

Main Methods:

• A secondary analysis was conducted using data from the Toxicology Investigators Consortium Core Registry, spanning January 2010 to March 2022.
• The study included 1,091 pediatric patients (≤18 years) with toxicologic exposure to cardiovascular medications across 40 international sites.

Main Results:

• Approximately 17.9% of patients required PICU intervention, with 14.4% receiving intensive hemodynamic support.
• Younger children (<2 years) were less likely to need PICU intervention (OR, 0.42).
• Exposures to alpha-2 agonists (OR, 2.0) and antiarrhythmics (OR, 4.26) were significantly associated with PICU intervention. Sensitivity analysis highlighted calcium channel antagonists (OR, 2.12) and antiarrhythmics (OR, 4.82) as key risk factors.

Conclusions:

• PICU interventions for pediatric cardiovascular medication exposures are infrequent but associated with specific drug classes.
• Age and exposure to certain cardiovascular agents like antiarrhythmics and calcium channel blockers are critical factors in determining the need for PICU care.
• These findings can aid in risk stratification and guide disposition decisions in cases of pediatric cardiovascular medication toxicity.