A case of Commotio cordis in a young child caused by a fall.
Commotio cordis or ventricular fibrillation caused by a blow to the chest is a rare cause of cardiac arrest in a well child. We report a case of a young child falling from a low height landing chest first with rapid onset of unconsciousness, apnoea and cyanosis. Cardiopulmonary resuscitation was given by parents under telephone instruction from an ambulance dispatch centre. On arrival of officers, 7 min after the fall, ventricular fibrillation was present but responded to defibrillation (biphasic 3 J/kg). No clinical or CT evidence of chest or brain trauma was present and investigations (ECGs, cardiac MRI, echocardiography, viral tests, metabolic tests, drug tests, serum electrolytes) did not reveal any cardiac illness or abnormal cardiac anatomy. Specifically, a long QT was absent and a Flecainide challenge for Brugada syndrome was negative. There was no family history of sudden death. No further dysrrhythmia occurred and the child recovered neurologically well after 3 days of therapeutic hypothermia (for cerebral ischaemia) and 7 days of mechanical ventilation.
Tibballs
James
J
Intensive Care Unit, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia. james.tibballs@rch.org.au
Thiruchelvam
Timothy
T
D000058:Accidental Falls; D016887:Cardiopulmonary Resuscitation; D002675:Child, Preschool; D004554:Electric Countershock; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D012121:Respiration, Artificial; D014693:Ventricular Fibrillation / Q000209:etiology* / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000150:complications*