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QTc prolongation after haloperidol administration in critically ill patients post cardiovascular surgery: A cohort study and review of the literature

Published online by Cambridge University Press:  29 April 2020

Burbuqe Ibrahimi ,
Soenke Boettger Open the ORCID record for Soenke Boettger [Opens in a new window] ,
Maria Schubert ,
Dominique Bettex  and
Alain Rudiger
Burbuqe Ibrahimi*
Affiliation:
Institute of Anaesthesiology, University of Zurich, University Hospital Zurich, Zurich, Switzerland Department of Cardiology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
Soenke Boettger
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatics, University of Zurich, University Hospital Zurich, Zurich, Switzerland
Maria Schubert
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatics, University of Zurich, University Hospital Zurich, Zurich, Switzerland
Dominique Bettex
Affiliation:
Institute of Anaesthesiology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
Alain Rudiger
Affiliation:
Institute of Anaesthesiology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
*
Author for correspondence: Burbuqe Ibrahimi, Institute of Anaesthesiology and Department of Cardiology, University of Zurich, University Hospital Zurich, Ramistrasse 100, 8091Zurich, Switzerland. E-mail: burbuqe.ibrahimi@usz.ch
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Abstract

Objective

From case reports, haloperidol administration has been associated with QTc prolongation, torsades de pointes, and sudden cardiac death. In a vulnerable population of critically ill patients after cardiac surgery, however, it is unclear whether haloperidol administration affects the QTc interval. Thus, the aim of this study is to explore the effect of haloperidol in low doses on this interval.

Method

This retrospective cohort study was performed on a cardio-surgical intensive care unit (ICU), screened 2,216 patients and eventually included 68 patients with delirium managed with oral and intravenous haloperidol. In this retrospective analysis, electrocardiograms were taken prior and within 24 h after haloperidol administration. The effect of haloperidol on QTc was determined with a Person correlation, and inter-group differences were measured with new long QT comparisons.

Results

In total, 68 patients were included, the median age was 71 (64–79) years and predominantly male (77%). Haloperidol administration followed ICU admission by three days and the cumulative dose was 4 (2–9) mg. As a result, haloperidol administration did not affect the QTc (r = 0.144, p = 0.23). In total, 31% (21/68 patients) had a long QT before and 27.9% (19/68 patients) after haloperidol administration. Only 12% (8/68 patients) developed a newly onset long QT. These patients were not different in the route of administration, cumulative haloperidol doses, comorbidities, laboratory findings, or medications.

Significance of results

These results indicated that low-dose intravenous haloperidol was safe and not clinically relevant for the development of a newly onset long QT syndrome or adverse outcomes and support recent findings inside and outside the ICU setting.

Keywords

Cardiac surgeryDeliriumHaloperidolICULong QTQTc time
Type
Original Article
Information
Palliative & Supportive Care , Volume 18 , Special Issue 4: Palliative and Supportive Care During The COVID-19 Pandemic , August 2020 , pp. 447 - 459
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Copyright
Copyright © Cambridge University Press 2020

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Footnotes

*

These authors shared first authorship.

†

This article has been updated since its original publication. See https://doi.org/10.1017/S1478951521000559.

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