Research Article| Volume 54, ISSUE 1, P15-18, January 2023

Pre-hospital CPR after traumatic arrest: Outcomes at a level 1 pediatric trauma center

Published:September 30, 2022DOI:


      • Children with pre-hospital traumatic cardiopulmonary arrest, particularly in those without pre-hospital ROSC have poor outcomes.
      • All children who did not obtain pre-hospital ROSC succumbed to their injuries in our study.
      • Prolonged CPR is common but rarely beneficial.
      • Where possible, parents should be allowed to witness and/or participate in end-of-life care.



      The survival of traumatic cardiopulmonary arrest (TCA) requiring pre-hospital cardiopulmonary resuscitation (P-CPR) is abysmal across age groups. We aim to describe the mechanisms of injury and outcomes of children suffering from TCA leading to P-CPR at our institution.


      A retrospective review was conducted to identify children ages 0-17 years who suffered TCA leading to P-CPR at our institution between 5/2009 and 3/2020. For analysis, patients were stratified into those still undergoing CPR at arrival and those who attained pre-hospital return of spontaneous circulation (ROSC). Primary outcome was discharge alive from the hospital.


      P-CPR was initiated for 48 patients who had TCA; 23 had pre-hospital ROSC. Of the 25 children undergoing CPR at presentation, none survived to discharge. The median duration of CPR, from initiation to time of death declaration was 34 min [29,50]. Seventeen patients died after resuscitation attempts in the ED, while 8 died after admission to the PICU. Of the 23 patients who attained pre-hospital ROSC, 6 survived to discharge. All survivors required intensive rehabilitation services at discharge and at most recent follow-up, 5 had residual deficits requiring medical attention.


      There are poor outcomes in children with pre-hospital traumatic cardiopulmonary arrest, particularly in those without pre-hospital ROSC. These data further support the need for standardized guidelines for resuscitation in children with traumatic cardiopulmonary arrest.


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