PDF(Pubmed)
Abstract：
Sudden cardiac arrest (SCA) studies are often population-based, limited to sudden cardiac death, and excluding infants. To guide prevention opportunities, it is essential to be informed of pediatric SCA etiologies. Unfortunately, etiologies frequently remain unresolved. The objectives of this study were to determine paediatric SCA etiology, and to evaluate the extent of post-SCA investigations and to assess the performance of previous cardiac evaluation in detecting conditions predisposing to SCA. In a retrospective cohort (2002-2019), all children 0-18 years with out-of-hospital cardiac arrest (OHCA) referred to Erasmus MC Sophia Children\'s Hospital or the Amsterdam UMC (tertiary-care university hospitals), with cardiac or unresolved etiologies were eligible for inclusion. SCA etiologies, cardiac and family history and etiologic investigations in unresolved cases were assessed. The etiology of arrest could be determined in 52% of 172 cases. Predominant etiologies in children ≥ 1 year (n = 99) were primary arrhythmogenic disorders (34%), cardiomyopathies (22%) and unresolved (32%). Events in children < 1 year (n = 73) were largely unresolved (70%) or caused by cardiomyopathy (8%), congenital heart anomaly (8%) or myocarditis (7%). Of 83 children with unresolved etiology a family history was performed in 51%, an autopsy in 51% and genetic testing in 15%. Pre-existing cardiac conditions presumably causative for SCA were diagnosed in 9%, and remained unrecognized despite prior evaluation in 13%.
CONCLUSIONS: SCA etiology remained unresolved in 83 of 172 cases (48%) and essential diagnostic investigations were often not performed. Over one-fifth of SCA patients underwent prior cardiac evaluation, which did not lead to recognition of a cardiac condition predisposing to SCA in all of them. The diagnostic post-SCA approach should be improved and the proposed standardized pediatric post-SCA diagnostics protocol may ensure a consistent and systematic evaluation process increasing the diagnostic yield.
BACKGROUND: • Arrests in infants remain unresolved in most cases. In children > 1 year, predominant etiologies are primary arrhythmia disorders, cardiomyopathy and myocarditis. • Studies investigating sudden cardiac arrest are often limited to sudden cardiac death (SCD) in 1 to 40 year old persons, excluding infants and successfully resuscitated children.
BACKGROUND: • In patients with unresolved SCA events, the diagnostic work up was often incompletely performed. • Over one fifth of victims had prior cardiac evaluation before the arrest, with either a diagnosed cardiac condition (9%) or an unrecognized cardiac condition (13%).
CONCLUSIONS: SCA etiology remained unresolved in 83 of 172 cases (48%) and essential diagnostic investigations were often not performed. Over one-fifth of SCA patients underwent prior cardiac evaluation, which did not lead to recognition of a cardiac condition predisposing to SCA in all of them. The diagnostic post-SCA approach should be improved and the proposed standardized pediatric post-SCA diagnostics protocol may ensure a consistent and systematic evaluation process increasing the diagnostic yield.
BACKGROUND: • Arrests in infants remain unresolved in most cases. In children > 1 year, predominant etiologies are primary arrhythmia disorders, cardiomyopathy and myocarditis. • Studies investigating sudden cardiac arrest are often limited to sudden cardiac death (SCD) in 1 to 40 year old persons, excluding infants and successfully resuscitated children.
BACKGROUND: • In patients with unresolved SCA events, the diagnostic work up was often incompletely performed. • Over one fifth of victims had prior cardiac evaluation before the arrest, with either a diagnosed cardiac condition (9%) or an unrecognized cardiac condition (13%).
摘要：
心脏骤停（SCA）研究通常是以人群为基础的，仅限于心脏性猝死，不包括婴儿。为了引导预防机会，了解小儿SCA病因至关重要.不幸的是,病因往往仍未解决。这项研究的目的是确定儿科SCA的病因，并评估SCA后调查的程度，并评估先前心脏评估在检测SCA易感条件方面的表现。在回顾性队列(2002-2019年)中，所有0-18岁的院外心脏骤停（OHCA）儿童均转诊至ErasmusMCSophia儿童医院或阿姆斯特丹UMC（三级护理大学医院），有心脏或未解决的病因符合纳入条件.SCA病因，对未解决病例的心脏病史和家族史以及病因学调查进行了评估.在172例中，有52％的人可以确定逮捕的病因。≥1岁儿童（n=99）的主要病因是原发性心律失常性疾病（34％），心肌病（22%）和未解决（32%）。1岁以下儿童（n=73）的事件大部分未解决（70％）或由心肌病引起（8％）。先天性心脏异常（8％）或心肌炎（7％）。在83名病因未解决的儿童中，有51％的人有家族史，51%的尸检和15%的基因检测。先前存在的心脏病可能是SCA的病因被诊断为9%，尽管事先评估了13%，但仍未得到认可。
结论：在172例病例中，有83例（48%）SCA病因仍未解决，通常未进行必要的诊断性检查。超过五分之一的SCA患者接受过心脏评估，这并没有导致识别出所有这些患者的心脏疾病易患SCA。应改进SCA后诊断方法，建议的标准化儿科SCA后诊断方案可以确保一致和系统的评估过程，从而提高诊断产量。
背景：•在大多数情况下，婴儿的逮捕仍未解决。在1岁以上的儿童中，主要病因是原发性心律失常，心肌病和心肌炎.•调查心脏骤停的研究通常仅限于1至40岁人群的心脏猝死（SCD）。排除婴儿和成功复苏的儿童。
背景：•在SCA事件未解决的患者中，诊断工作通常不完全进行.•超过五分之一的受害者在停搏前进行了心脏评估，诊断为心脏病（9％）或未识别的心脏病（13％）。
结论：在172例病例中，有83例（48%）SCA病因仍未解决，通常未进行必要的诊断性检查。超过五分之一的SCA患者接受过心脏评估，这并没有导致识别出所有这些患者的心脏疾病易患SCA。应改进SCA后诊断方法，建议的标准化儿科SCA后诊断方案可以确保一致和系统的评估过程，从而提高诊断产量。
背景：•在大多数情况下，婴儿的逮捕仍未解决。在1岁以上的儿童中，主要病因是原发性心律失常，心肌病和心肌炎.•调查心脏骤停的研究通常仅限于1至40岁人群的心脏猝死（SCD）。排除婴儿和成功复苏的儿童。
背景：•在SCA事件未解决的患者中，诊断工作通常不完全进行.•超过五分之一的受害者在停搏前进行了心脏评估，诊断为心脏病（9％）或未识别的心脏病（13％）。
