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

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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 develo** 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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Funding

None. There are no relationships with industry.

Author information

Author notes

  1. Joel A. Kirsh

    Present address: Forensic Services and Coroners Complex, Office of the Chief Coroner for Ontario, Toronto, Canada

Authors and Affiliations

  1. Department of Pediatrics, Abdullah Bakhsh Children’s Heart Center, King Abdulaziz University, PO Box 80215, Jeddah, 21589, Saudi Arabia

    Khadijah Maghrabi

  2. Department of Paediatric Cardiology, University Hospital Wales, Cardiff, UK

    Orhan Uzun

  3. Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Joel A. Kirsh

  4. Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA

    Seshadri Balaji

  5. The University of Wisconsin, Madison, WI, USA

    Nicholas H. Von Bergen

  6. Children’s Heart Centre, University of British Columbia, Vancouver, BC, Canada

    Shubhayan Sanatani

Authors
  1. Khadijah Maghrabi
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  2. Orhan Uzun
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Correspondence to Khadijah Maghrabi.

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The authors declare that they have no conflict of interest.

Ethical Approval

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

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Maghrabi, K., Uzun, O., Kirsh, J.A. et al. Cardiovascular Collapse with Intravenous Amiodarone in Children: A Multi-Center Retrospective Cohort Study. Pediatr Cardiol 40, 925–933 (2019). https://doi.org/10.1007/s00246-019-02090-7

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  • DOI: https://doi.org/10.1007/s00246-019-02090-7

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