Resuscitation in Paediatric Cardiac Patients: Michele Domico
Michele Domico presents a talk on the pitfalls of common paediatric resuscitative manoeuvres in paediatric cardiac patients.
Emergency and critical care physicians are all well accustomed to items such as oxygen, bolus adrenaline, intubation and cardioversion.
However, as Michele explains, these ‘go to’ interventions may in fact be harmful for the paediatric cardiac patient presenting to the emergency department in extremis.
Due to the physiology of certain complex congenital heart diseases, the usual resuscitation manoeuvres may in fact kill the patient instead of helping. Supplemental oxygen can worsen the pulmonary to systemic blood flow ratio in single ventricle patients. Furthermore, it can cause them to have rising lactate levels and cardiac arrest from low systemic cardiac output.
Intubation and positive pressure ventilation may impede pulmonary blood flow in patients with a Glenn shunt and the patient can become more desaturated. With increasing PEEP and higher respiratory rates, the patients will continue to deteriorate and desaturate.
Regular dosing of adrenaline boluses in patients with single ventricle physiology who are nearly arrest, can worsen their systemic output by increasing systemic vascular resistance and promoting pulmonary overcirculation.
Cardioversion of a previously healthy paediatric patient might be tempting when you see what looks like a stable ventricular tachycardia. This wide complex rhythm has fooled many people into shocking it. You might in fact be dealing with something else and can make the patient infinitely worse by shocking.
In her talk, Michele highlights the importance of understanding the physiology of your patients. This particularly applies to paediatric cardiac patients.
In this population, the change from typical physiology means standard models of care are harmful. Tune in to hear what not to do!
Resuscitation in Paediatric Cardiac Patients: Michele Domico
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Michele Domico
Dr. Domico is board certified in both pediatrics and pediatric critical care medicine. Dr. Domico worked in London at the world-renowned Great Ormond Street Hospital for Children as a senior fellow in pediatric cardiac intensive care/ECMO. She completed her pediatric critical care fellowship at Harbor-UCLA Medical Center and CHOC Hospital in Orange. She received additional fellowship training in pediatric cardiology at the University of Florida Health Science Center. Dr. Domico attended medical school and completed her internship and residency at University of Texas Health Science Center in San Antonio.
