Emergency Department, ICU, and Inpatient Clinical Pathway
for Children with Suspected Acute Heart Failure
- Differential Diagnosis
- Sepsis
- Metabolic disease
- Acute abdomen
- Acute gastroenteritis
- Asthma, ED
- Asthma, inpatient
- Bronchiolitis, ED
- Bronchiolitis, inpatient
- Pneumonia
- Congenital heart disease
| High Risk for Acute Heart Failure | |
|---|---|
|
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- Cardiorespiratory Failure
- Resuscitation
- Cardiology consult
- ECMO Considerations
ED Team Assessment
- History and Physical
- ABCDE, mental status
- Monitor VS
- Consider O2 therapy
- Immediate IV access
Initial Labs and Imaging
- CBC, troponin-I, BNP, BMP, LFTs
- CXR, ECG
- VBG lactate, mixed venous O2 saturation from central line access
- Cardiac POCUS as adjunct to physical assessment
Epic Consult Card Txp/Heart Failure
Warm and Wet
Cold and Wet
Cold and Dry
- Increased ventricular filling pressures
- Pulmonary edema with adequate perfusion
- Increased ventricular filling pressures
- Pulmonary edema with poor perfusion
- Normal ventricular filling pressures
- Poor perfusion with volume depletion
Persistent symptoms
Improved function, symptom relief
- Respiratory support
- Mechanical support
- Anticoagulation
- Chronic IV inotrope (milrinone)
- Transplant
Discharge planning
Evidence
- The International Society for Heart and Lung Transplantation Guidelines for the Management of Pediatric Heart Failure
- Heart Failure in Children: Etiology and Treatment
- 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure
- Patient and Device Selection in Pediatric MCS: A Review of Current Consensus and Unsettled Questions
CHOP Program