Recognition and Management of Hyperkalemia-Induced Tachyarrhythmia in Pediatric Spontaneous Tumor Lysis Syndrome: A Simulation Case

INTRODUCTION: Prompt recognition and treatment of hyperkalemia-induced arrhythmias in children is vital, as these can be life-threatening. Tumor lysis syndrome (TLS) can present with severe hyperkalemia, which, if untreated, may lead to renal failure, arrhythmias, or multi-organ failure. Simulation offers a safe way for providers to practice managing such acute scenarios. While prior simulations address hyperleukocytosis, few focus on metabolic complications like hyperkalemia in spontaneous TLS. This high-fidelity simulation aimed to improve participants' confidence in recognizing and managing pediatric ventricular tachycardia due to hyperkalemia from TLS. METHODS: This prospective simulation-based study was conducted by pediatric emergency, general emergency, and hematology-oncology physicians who developed the simulation for pediatric and emergency medicine providers. Participants managed a case of a school-aged child with hyperkalemia-induced arrhythmia due to spontaneous TLS, progressing to oliguria. Conducted in a simulated ED setting with a high-fidelity manikin, the scenario required clinical interpretation and intervention. The primary outcome was participant self-reported confidence in recognizing and managing hyperkalemia-induced ventricular tachycardia in the context of TLS. Secondary outcomes included objective critical action performance metrics, including time to arrhythmia recognition, time to recognition of anuria, and differential diagnoses generated during the scenario. A structured debrief, following the Promoting Excellence and Reflective Learning in Simulation (PEARLS) framework, followed each session with content expertise provided by a pediatric hematology/oncologist. Participants completed post-simulation surveys on confidence, practice impact, and feedback. Data was analyzed descriptively, with results reported as frequencies or percentages. RESULTS: Ninety-two participants completed the survey. Fewer than 25% had previously managed TLS or related arrhythmias. A total of 99% (N=91) found the simulation relevant, and 83% (N=76) reported increased confidence in recognizing and managing ventricular tachycardia due to hyperkalemia. CONCLUSIONS: This descriptive study demonstrated the effectiveness of high-fidelity simulation in improving provider confidence and preparedness for managing rare, high-acuity presentations such as spontaneous TLS with hyperkalemia-induced ventricular tachycardia. Participants valued its relevance, realism, and applicability. These findings lay the groundwork for future comparative and longitudinal research, including in situ implementation with interdisciplinary teams.