Cardiac arrest as initial presentation of Kawasaki disease with giant coronary aneurysms: A case report and review of literature

Table 1 Clinical and laboratory characteristics at from disease onset to discharge

	Clinical status	Laboratory findings	Imaging	Interventions
Local hospital	Cardiac arrest, CPR for 45 minutes and return of spontaneous circulation, pink frothy sputum, GCS 4 points	WBC: 20.5 × 109/L, AST: 385 IU/L, ALT: 175 IU/L, hs-cTnI: 2.3 ng/mL	Echocardiography: Coronary artery aneurysm (LMCA: 4.8 mm, LAD: 8 mm, RCA: 7.5 mm), RCA thrombus; chest X-ray: Acute pulmonary edema	CPR, intubation, vasopressors (adrenaline, noradrenaline)
Emergency Department	GCS 4 points, shock status, VIS 210, CRT > 3 seconds	pH = 7.14, serum lactate > 13.3 mmol/L, troponin I > 50 μg/L, serum ferritin > 1676 μg/L, INR = 8.03	ECG: ST depression in leads-DI, aVL. Echocardiography: Giant coronary artery aneurysm (LMCA diameter = 1.6 mm, LAD: 7.5 mm, RCA diameter = 8.1 mm), thrombus in RCA	Mechanical ventilation, IVIG (2 g/kg), vasopressors, intravenous antibiotic (cefepime) and heparin
Before CRRT and TPE	Shock status, respiratory failure, GCS 4 points, acute kidney injury	AST: 3670 IU/L, ALT: 1029 IU/L, serum ferritin > 1676 μg/L, INR = 8.03	Echocardiography: Giant coronary artery aneurysm, EF 55%-60%	Vasopressors, IVIG, methylprednisolone 10 mg/kg/day, CRRT, anti-cerebral edema therapy (NaCl 3%)
After CRRT and TPE	Hemodynamic stability (VIS 47)	AST: 222 IU/L, ALT: 32 IU/L, serum ferritin: 1784 μg/L, INR = 1.32	Chest X-ray: Improvement in pulmonary injury; echocardiography: Coronary artery aneurysm, absence of thrombus	Combined CRRT and TPE, intravenous heparin and corticosteroids
At PICU discharge	Alert (GCS 14 points), extubation and enteral feeding	AST: 54 IU/L, ALT: 75 IU/L, serum ferritin: 776 μg/L	Echocardiography: Coronary artery aneurysm, EF 62%; brain magnetic resonance imaging: Normal findings	Aspirin, ceasing vasopressors, transferred to the Cardiology Unit for further sustained therapies

CPR: Cardiopulmonary resuscitation; WBC: White blood cell; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; LMCA: Left main coronary artery; LAD: Left anterior descending artery; RCA: Right coronary artery; GCS: Glasgow Coma Scale; VIS: Vasoactive-inotropic score; INR: International normalized ratio; ECG: Echocardiography; IVIG: Intravenous immunoglobin; CRRT: Continuous renal replacement therapy; TPE: Therapeutic plasma exchange; EF: Ejection fraction; PICU: Pediatric intensive care unit.