Highlights
- •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.
Abstract
Background
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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: September 30, 2022
Accepted:
September 28,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
