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Cardiovascular Collapse with Intravenous Amiodarone in Children: A Multi-Center Retrospective Cohort Study

  • Khadijah MaghrabiEmail author
  • Orhan Uzun
  • Joel A. Kirsh
  • Seshadri Balaji
  • Nicholas H. Von Bergen
  • Shubhayan Sanatani
Original Article
  • 137 Downloads

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.

Keywords

Arrhythmia Amiodarone Collapse Atrioventricular node Tachycardia Congenital heart defects Pediatrics 

Notes

Funding

None. There are no relationships with industry.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was approved by the review board at each participating center.

Informed Consent

For this type of study formal consent is not required.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Khadijah Maghrabi
    • 1
    Email author
  • Orhan Uzun
    • 2
  • Joel A. Kirsh
    • 3
    • 4
  • Seshadri Balaji
    • 5
  • Nicholas H. Von Bergen
    • 6
  • Shubhayan Sanatani
    • 7
  1. 1.Department of Pediatrics, Abdullah Bakhsh Children’s Heart CenterKing Abdulaziz UniversityJeddahSaudi Arabia
  2. 2.Department of Paediatric CardiologyUniversity Hospital WalesCardiffUK
  3. 3.Department of Pediatrics, The Hospital for Sick ChildrenUniversity of TorontoTorontoCanada
  4. 4.Forensic Services and Coroners Complex, Office of the Chief Coroner for OntarioTorontoCanada
  5. 5.Department of PediatricsOregon Health and Science UniversityPortlandUSA
  6. 6.The University of WisconsinMadisonUSA
  7. 7.Children’s Heart CentreUniversity of British ColumbiaVancouverCanada

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