Catecholaminergic Polymorphic Ventricular Tachycardia: Challenges During Resuscitation and Post-Cardiac Arrest Care

Smooth Emergence from General Anesthesia after Deep Extubation in a Pediatric Patient Diagnosed with Catecholaminergic Polymorphic Ventricular Tachycardia: A Case Report

Background: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare genetic disorder where catecholamine causes bidirectional ventricular tachycardia, potentially leading to cardiac arrest. In patients undergoing surgery, sympathetic responses can be triggered in situations associated with surgical stimulations as well as high anxiety before the surgery, anesthetic maneuvers such as endotracheal intubation and extubation, and postoperative pain. Therefore, planning for surgery demands meticulous attention to anesthesia during the perioperative period in order to prevent potentially life-threatening arrhythmias. Case: We discuss a case of an 11-year-old male pediatric patient with known CPVT who required elective strabismus surgery for exotropia involving both eyes. After thorough planning of general anesthesia to minimize catecholamine response, sufficient anesthesia and analgesia were achieved to blunt the stressful response during intubation and maintained throughout the surgical procedure. Complete emergence was achieved after deep extubation, and the patient did not complain of pain or postoperative nausea and vomiting. Conclusions: Anesthesiologists should not only be able to plan and manage the catecholamine response during surgery but also anticipate and be prepared for situations that may lead to arrhythmias before and after the procedure. In certain cases, deep extubation can be beneficial as it reduces hemodynamic changes during the extubation process.

Cardiac Arrest From Undiagnosed Catecholaminergic Polymorphic Ventricular Tachycardia: A Case Report

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited heart disease in which exercise or acute emotional stress can cause potentially fatal tachyarrhythmias. We present the case of a 16-year-old female patient with a history of unexplained palpitations and syncope who suddenly collapsed in her high school cafeteria following an impassioned debate. In cardiac arrest consisting of coarse ventricular fibrillation, she was resuscitated on-scene by the school nurse via automated external defibrillation. Months later, after substantial investigation, a diagnosis of CPVT was reached. The patient made a full neurological recovery, and one year post-arrest, she was event-free on β-blocker therapy. This case demonstrates the importance of clinician awareness of CPVT, an unusual but treatable cause of cardiac arrest. Because catecholamine administration is directly contraindicated for patients with CPVT, resuscitative and post-arrest care are unique. These patients tend to be previously healthy, with normal resting electrocardiograms and no cardiac structural abnormalities, making diagnosis quite challenging.

Evidence Summary of Temperature Management for Comatose Patients after Cardiopulmonary Resuscitation in ICUs

Objective

This study aims to select and summarize the best evidence of temperature management for comatose patients after cardiopulmonary resuscitation in intensive care units (ICUs) at home and abroad.

Method

Some well-known databases at home and abroad have been searched to find the guidelines, expert consensus, original documents, evidence summaries, and systematic evaluation about temperature management for comatose patients after cardiopulmonary resuscitation in ICUs. The databases included PubMed, Up to Date, Cochrane Library, the website of Registered Nurses' Association of Ontario, the Guideline Library of National Institute for Health and Clinical Excellence of the UK, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP. The period for search is from the establishment of each database to the present. Two researchers who have received evidence-based nursing training and passed the examination evaluated, extracted, and integrated the literature quality with a blind method to summarize the best evidence.

Results

A total of 10 pieces of literature were included in this study, including 4 in Chinese and 6 in English. Specifically, there were 4 guidelines, 1 expert consensus, 2 evidence summaries, 1 systematic evaluation, 1 literature review, and 1 comparative experiment, accounting for 40.0%, 10.0%, 20.0%, 10.0%, 10.0%, and 10.0%, respectively. The literature and materials were all qualified, and there was no heterogeneity and no significant publication bias in the included literature. The best evidence involved mild hypothermia therapy, rewarming, prevention of mild hypothermia-related complications, and nutritional support, with a total of 21 pieces of evidence (including 11, 3, 5, and 2 pieces of evidence, respectively). In terms of the recommendation grade, 7 pieces of evidence were at Grade A and 14 at Grade B.

Conclusion

Health care providers should implement hypothermia management in comatose patients after cardiopulmonary resuscitation in ICUs, pay attention to the prevention of related complications, and provide enteral nutrition support.