Friday, April 20, 2012

sudden cardiac arrest in children

From CHOP Expert Commentary

Sudden Cardiac Arrest: Identifying Kids at Risk

Victoria L. Vetter, MD, MPH

Posted: 04/09/2012

I am Dr. Victoria Vetter, a pediatric cardiologist at the Children's Hospital in Philadelphia. I'm speaking to you today about a policy statement just published by the American Academy of Pediatrics on pediatric sudden cardiac arrest. This paper identifies the conditions that are associated with sudden cardiac arrest in children. This can include structural functional abnormalities, such as hypertrophic cardiomyopathy and dilated cardiomyopathy; coronary anomalies; electrical conditions, such as long QT syndrome; and acquired conditions, such as commotio cordis, when there is a blow to the chest.
The paper outlines the warning signs and symptoms associated with sudden cardiac arrest. This would include fainting or syncope with exercise, chest pain with exercise, shortness of breath not associated with asthma in response to exercise, a family history of sudden cardiac arrest in someone younger than 50 years of age, or having a member who might be affected with one of the conditions that can cause sudden cardiac arrest.
Unfortunately, many individuals do not know their family history, but this is very important. Pediatric providers should make every attempt to investigate this in all children they are seeing, particularly those who are active, as sudden cardiac arrest is most likely to occur during activity. Of course, this includes most of our children. Providers also should be asking questions that specifically relate to the symptoms that were previously mentioned. Since this is a genetic condition, a molecular or genetic evaluation of affected family members or children who experience sudden cardiac arrest can often identify the cause of the arrest and identify additional individuals.
While we do not have a registry that counts the number of children who experience a sudden cardiac arrest, we are hopeful that the information in this policy statement will encourage people to consider that option, and thus identify the children who are experiencing these conditions. Further, if a school has an automated external defibrillator (AED) and an emergency plan to activate when such an event occurs, the child is much more likely to survive. Currently, the survival rate is 10%. It can be as high as 64% in schools where an emergency response plan is in effect.
Also, we would hope that individuals involved in schools would use this as an opportunity to develop curricula that include cardiopulmonary resuscitation and AED use. Every child who graduates from high school could then become a community bystander who would be available to help resuscitate an individual should they experience a sudden cardiac arrest.
The ways in which children can be identified with this condition include the warning signs and symptoms mentioned above. Unfortunately, symptoms are present in less than 50% of individuals. Thus, there is much discussion in the country at this time about other ways in which we might identify these individuals, including a debate about whether an electrocardiogram, which can identify up to 70%-95% of these conditions, should be used and whether genetic testing should be used in a more proactive fashion.
The paper concludes with a number of recommendations about the ways in which pediatricians may effectively work toward decreasing the tragedy of sudden cardiac arrest in our children.


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