Sudden unexpected cardio-respiratory arrest after venipuncture in childre

Jeong, G., Shin, S.M., Kim, N.S. and Ahn, Y.M. (2018) Sudden unexpected cardio-respiratory arrest after venipuncture in children. Korean Journal of Pediatrics. 61(4), p.108-113.

doi: 10.3345/kjp.2018.61.4.108.

PURPOSE: This study aimed to investigate the clinical and socio-environmental 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, socio-environmental 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.

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