Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Sudden unexpected cardio-respiratory arrest after venipuncture in children

  • Jeong, Goun (Department of Pediatrics, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine) ;
  • Shin, Son Moon (Department of Pediatrics, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine) ;
  • Kim, Nam Su (Department of Pediatrics, Hanyang University College of Medicine) ;
  • Ahn, Young Min (Department of Pediatrics, Eulji General Hospital, Eulji University School of Medicine)
  • Received : 2017.07.14
  • Accepted : 2017.12.29
  • Published : 2018.04.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study aimed to investigate the clinical and socioenvironmental characteristics of sudden cardiorespiratory arrest after venipuncture in children. Methods: We conducted a retrospective email-based survey of all members of the Korean Pediatric Society. The questionnaire included items on patient demographics, socioenvironmental circumstances of the venipuncture, type of cardiorespiratory arrest, symptoms and signs, treatment, prognosis, and presumed cause of the arrest. Results: Fourteen patients were identified. Of these, 13 were young children (<2 years old), and 1 was 14 years old. All patients had been previously healthy and had no specific risk factors for sudden cardiorespiratory arrest. Most cases (n=11, 79%) were defined as cardiac or cardiorespiratory arrest, while the remaining cases (n=3, 21%) were defined as respiratory arrest. Aspiration (n=3), acute myocarditis (n=2), and laryngeal chemoreflex (n=1) were presumed as the causes; however, the exact causes were unclear. The overall prognosis was poor (death, n=7; morbidity, n=5; full recovery, n=2). The medical institutions faced severe backlash because of these incidents (out-of-court settlement, n=5; medical lawsuit, n=5; continuous harassment, n=3). Conclusion: Cardiorespiratory arrest after venipuncture is unpredictable and the probable cause of most cases is a vasovagal reaction. Medical personnel must be aware of the risk of unexpected cardiorespiratory arrest during routine intravenous procedures.

Keywords

References

  1. Tizes R. Cardiac arrest following routine venipuncture. JAMA 1976;236:1846-7. https://doi.org/10.1001/jama.1976.03270170012013
  2. Nash ES, Horton JN. Cardiac standstill following venepuncture: a report of the subsequent management of the case. Br J Oral Surg 1978;16:70-2. https://doi.org/10.1016/S0007-117X(78)80058-4
  3. Roddy SM, Ashwal S, Schneider S. Venipuncture fits: a form of reflex anoxic seizure. Pediatrics 1983;72:715-8.
  4. Betsuyaku T, Kumamoto H, Yokosiki N, Nomura T, Yosida I, Sakurai M, et al. A case of vasovagal syncope associated with venipuncture. Kokyu To Junkan 1992;40:831-3.
  5. Lipton JD, Forstater AT. Recurrent asystole associated with vasovagal reaction during venipuncture. J Emerg Med 1993;11:723-7. https://doi.org/10.1016/0736-4679(93)90632-H
  6. Cho EJ, Rho TH, Kim HY, Kim CJ, Lee MY, Jin SW, et al. Recurrent asystoles associated with vasovagal reaction during venipuncture. Korean J Intern Med 2000;15:232-5. https://doi.org/10.3904/kjim.2000.15.3.232
  7. McKay RJ Jr. Diagnosis and treatment: risks of obtaining samples of venous blood in infants. Pediatrics 1966;38:906-8.
  8. Ruetz PP, Johnson SA, Callahan R, Meade RC, Smith JJ. Fainting: a review of its mechanisms and a study in blood donors. Medicine (Baltimore) 1967;46:363-84. https://doi.org/10.1097/00005792-196709000-00001
  9. Ogata H, Iinuma N, Nagashima K, Akabane T. Vasovagal reactions in blood donors. Transfusion 1980;20:679-83. https://doi.org/10.1046/j.1537-2995.1980.20681057157.x
  10. France CR, France JL, Carlson BW, Himawan LK, Stephens KY, Frame-Brown TA, et al. Fear of blood draws, vasovagal reactions, and retention among high school donors. Transfusion 2014;54(3 Pt 2):918-24. https://doi.org/10.1111/trf.12368
  11. Liberthson RR. Sudden death from cardiac causes in children and young adults. N Engl J Med 1996;334:1039-44. https://doi.org/10.1056/NEJM199604183341607
  12. Alapati S, Strobel N, Hashmi S, Bricker JT, Gupta-Malhotra M. Sudden unexplained cardiac arrest in apparently healthy children: a single-center experience. Pediatr Cardiol 2013;34:639-45. https://doi.org/10.1007/s00246-012-0516-0
  13. Chen MY, Goldenberg IF, Milstein S, Buetikofer J, Almquist A, Lesser J, et al. Cardiac electrophysiologic and hemodynamic correlates of neurally mediated syncope. Am J Cardiol 1989;63:66-72. https://doi.org/10.1016/0002-9149(89)91077-1
  14. Morillo CA, Eckberg DL, Ellenbogen KA, Beightol LA, Hoag JB, Tahvanainen KU, et al. Vagal and sympathetic mechanisms in patients with orthostatic vasovagal syncope. Circulation 1997;96:2509-13. https://doi.org/10.1161/01.CIR.96.8.2509
  15. Shim SH, Park SY, Moon SN, Oh JH, Lee JY, Kim HH, et al. Baseline heart rate variability in children and adolescents with vasovagal syncope. Korean J Pediatr 2014;57:193-8. https://doi.org/10.3345/kjp.2014.57.4.193
  16. Noh CI. Syncope in Infants and Children. J Korean Pediatr Soc 1998;41:577-84.
  17. Thomson HL, Wright K, Frenneaux M. Baroreflex sensitivity in patients with vasovagal syncope. Circulation 1997;95:395-400. https://doi.org/10.1161/01.CIR.95.2.395
  18. Engel GL. Psychologic stress, vasodepressor (vasovagal) syncope, and sudden death. Ann Intern Med 1978;89:403-12. https://doi.org/10.7326/0003-4819-89-3-403
  19. McIntosh HD. The stabilizing and unstabilizing influences of neurogenic and vascular activities of the heart as related to sudden cardiac death. J Am Coll Cardiol 1985;5(6 Suppl):105B-110B. https://doi.org/10.1016/S0735-1097(85)80537-4
  20. Milstein S, Buetikofer J, Lesser J, Goldenberg IF, Benditt DG, Gornick C, et al. Cardiac asystole: a manifestation of neurally mediated hypotension-bradycardia. J Am Coll Cardiol 1989;14:1626-32. https://doi.org/10.1016/0735-1097(89)90006-5
  21. Adelson L, Kinney ER. Sudden and unexpected death in infancy and childhood. Pediatrics 1956;17:663-99.
  22. Dennert R, Crijns HJ, Heymans S. Acute viral myocarditis. Eur Heart J 2008;29:2073-82. https://doi.org/10.1093/eurheartj/ehn296
  23. American Academy of Pediatrics. Section on Cardiology and Cardiac Surgery. Pediatric sudden cardiac arrest. Pediatrics 2012;129:e1094-102. https://doi.org/10.1542/peds.2012-0144
  24. Eder AF, Dy BA, Kennedy JM, Notari Iv EP, Strupp A, Wissel ME, et al. The American Red Cross donor hemovigilance program: complications of blood donation reported in 2006. Transfusion 2008;48:1809-19. https://doi.org/10.1111/j.1537-2995.2008.01811.x
  25. Newman BH, Newman DT, Ahmad R, Roth AJ. The effect of wholeblood donor adverse events on blood donor return rates. Transfusion 2006;46:1374-9. https://doi.org/10.1111/j.1537-2995.2006.00905.x
  26. World Health Organization. WHO guidelines on drawing blood: best practices in phlebotomy. Geneva (Switzerland): World Health Organization, 2010.
  27. Mantia AM, Phillips OC. Lidocaine skinwheal fails to prevent vasovagal reflex during venipuncture. W V Med J 1987;83:273-4.
  28. Kinsella SM, Tuckey JP. Perioperative bradycardia and asystole: relationship to vasovagal syncope and the Bezold-Jarisch reflex. Br J Anaesth 2001;86:859-68. https://doi.org/10.1093/bja/86.6.859
  29. Academy of Breastfeeding M. ABM Clinical Protocol #25: Recommendations for preprocedural fasting for the breastfed infant: "NPO" Guidelines. Breastfeed Med 2012;7:197-202 https://doi.org/10.1089/bfm.2012.9988