Giant R waves on electrocardiogram in children with asphyxia after cardiopulmonary resuscitation

• Published in: Medicine: Case Reports and Study Protocols
• Main Authors: Guo, QiFeng, Chen, YueE., Xu, XiangLin
• Format: Article in Journal/Newspaper
• Language: English
• Published: Ovid Technologies (Wolters Kluwer Health) 2021
• Subjects: General Earth and Planetary Sciences; General Environmental Science; Ice cap
• Online Access: http://dx.doi.org/10.1097/md9.0000000000000169; https://journals.lww.com/10.1097/MD9.0000000000000169

Abstract Introduction: Giant R waves on electrocardiogram (ECG) in pediatric patients is extremely rare. The present case report explores the giant R wave ECG characteristics and clinical features of children with asphyxia after cardiopulmonary resuscitation. Patient concerns: Two children presented with suffocation due to drowning and foreign body inhalation. Cardiopulmonary resuscitation was performed, and the children were admitted to the hospital. Diagnosis: On the day of admission, the two children were in a deep coma, with decreased blood pressure, elevated myocardial enzymes and glucose, and metabolic acidosis. However, ECG examination showed no obvious abnormalities. On the day after admission, the children experienced frequent convulsions. The ECG showed the features of giant R waves from three consecutive ECG readings. Interventions: Treatment measures during hospitalization included tracheal intubation assisted ventilation, ice cap to protect the brain to reduce basal brain metabolism, anti-infection, dehydration, lower intracranial pressure, correction of acidosis, adjustment of glucose levels, sedation, analgesia, normal saline to supplement blood volume and protect liver function. Outcomes: The giant R waves on ECG persisted until the children passed away three days after admission. Conclusion: Giant R waves on ECG in children with asphyxia after cardiopulmonary resuscitation may be related to the large release of catecholamines, which results in myocardial injury. Giant R waves on ECG indicates a serious illness and poor prognosis of the patient. In addition, giant R waves on ECG may be misdiagnosed as other arrhythmias and needs to be carefully differentiated.