Factors affecting survival in pediatric cardiac tamponade caused by central venous catheters

Abstract

Pediatric central venous catheter (CVC) placement is useful but associated with complications such as cardiac tamponade. We aimed to identify risk factors for death in cardiac tamponade. Published articles on pediatric CVC-associated cardiac tamponade were obtained by searching PubMed and Google and retrospectively reviewed to analyze risk factors for death. Factors examined for their effect on mortality risk included patient age, weight, CVC size, days from CVC insertion to tamponade occurrence, substances administered, insertion site, treatment, CVC material, and initial CVC tip position. Of 110 patients reported in 62 articles, 69 survived and 41 died. Among survivors, 55 of 69 patients were treated; among deaths, only 7 of 38 (OR 537.9, 95% CI 29.3-9,877, p < 0.0001). Multiple regression analysis in 44 cases showed that treatment (p < 0.0001) and initial CVC tip position (p = 0.020) were independent predictive factors related to improved cardiac tamponade survival. Past studies have mainly discussed how to avoid pediatric cardiac tamponade; by contrast, the present study focused on how to avoid deaths. The findings of this review suggest that cardiac tamponade survival is better when tamponade is detected early and treated promptly and might be affected by initial CVC tip position.

Tamponade and massive pleural effusions secondary to peripherally inserted central catheter in neonates–A complication to be aware of

“…In our study, three out of the four cases were extremely premature neonates, with extremely low birth weight. Nevertheless, studies have not discovered a correlation between gestational age or weight and the incidence of tamponade secondary to neonatal PICC (14)(15)(16). The management of pericardial effusions is controversial and greatly depends on the size of the effusions and the patient's clinical status.…”

Pericardial Effusion/Cardiac Tamponade Induced by Peripherally Inserted Central Catheters in Very Low Birth Weight Infants: A Case Report and Literature Review

“…PCE/CT has a variety of clinical manifestations, such as dyspnea, bradycardia, and hypotension; however, owing to the lack of specific clinical manifestations, the diagnosis of PCE/CT is difficult, and without immediate treatment, the mortality rate is often high. The currently known risk factors for PICC-induced PCE/CT include catheter tip position, catheter drift, and infusion of hypertonic fluid (15)(16)(17).…”

Tamponamento cardíaco por cateter central de inserção periférica em prematuros: papel da ultrassonografia à beira do leito e abordagem terapêutica.

“…Some studies have shown that there is no difference in the risk of death from cardiac tamponade related to PICC for factors such as gestational age and weight 16,17 . Regarding general mortality among newborns with this condition, Nowlen et al 16 12,20,21 , reviews or meta-analyzes [15][16][17] . In the last 13 years, there have been original studies evaluating the complications related to the use of PICC 7,8,19,22 .…”