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Cardiac arrests in children are fortunately rare and the presenting cardiac rhythm is often asystole. However, ventricular fibrillation (VF) can occur and may respond favourably to defibrillation.
A 7 month old girl was sitting in her high chair when she was witnessed by her parents to collapse suddenly at 1707 hours. They attempted cardiopulmonary resuscitation (CPR) and the ambulance crew arrived 7 minutes later, the cardiac monitor displaying VF. No defibrillation or medications were administered and she was rapidly transferred to her nearest emergency department (ED), arriving at 1723. She had been previously fit and well, and had not had respiratory difficulties prior to her arrest.
She was in cardiorespiratory arrest on arrival to the ED. She was promptly endotracheally intubated and intraosseous access obtained. Cardiac rhythm on arrival was asystole. She responded with a return of spontaneous circulation following 30 minutes of resuscitation with atropine, adrenaline, and sodium bicarbonate. She was transferred to the paediatric intensive care unit (PICU) on an adrenaline infusion.
On arrival in the PICU, further investigation, including a transthoracic echocardiogram, revealed a right atrial mass suspicious of a right atrial tumour, which was confirmed by transoesophageal echo. Following a stable night, the patient had a further VF arrest at 0700 the following morning, which responded favourably to adrenaline and a single 2 J/kg shock.
The patient was then transferred urgently to cardiac theatre and underwent resection of the tumour from …
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