Advertisement

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

Published:September 30, 2022DOI:https://doi.org/10.1016/j.injury.2022.09.059

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Alqudah Z.
        • Nehme Z.
        • Alrawashdeh A.
        • Williams B.
        • Oteir A.
        • Smith K.
        Paediatric traumatic out-of-hospital cardiac arrest: a systematic review and meta-analysis.
        Resuscitation. 2020; 149: 65-73https://doi.org/10.1016/j.resuscitation.2020.01.037
        • Griffith B.
        • Kochanek P.
        • Dezfulian C.
        The benefits of youth are lost on the young cardiac arrest patient.
        F1000Research. 2017; 6 (Published 2017 Jan 25): 77https://doi.org/10.12688/f1000research.9316.1
        • De Maio V.J.
        • Osmond M.H.
        • Stiell I.G.
        • et al.
        Epidemiology of out-of hospital pediatric cardiac arrest due to trauma.
        Prehosp Emerg Care. 2012; 16: 230-236https://doi.org/10.3109/10903127.2011.640419
        • American College of Surgeons Committee on Trauma; American College of Emergency Physicians Pediatric Emergency Medicine Committee; National Association of EMS Physicians; American Academy of Pediatrics Committee on Pediatric Emergency Medicine, Fallat ME
        Withholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest.
        Pediatrics. 2014; 133: e1104-e1116https://doi.org/10.1542/peds.2014-0176
        • Millin M.G.
        • Galvagno S.M.
        • Khandker S.R.
        • et al.
        Withholding and termination of resuscitation of adult cardiopulmonary arrest secondary to trauma: resource document to the joint NAEMSP-ACSCOT position statements.
        J Trauma Acute Care Surg. 2013; 75: 459-467https://doi.org/10.1097/TA.0b013e31829cfaea
        • Tataris K.L.
        • Richards C.T.
        • Stein-Spencer L.
        • Ryan S.
        • Lazzara P.
        • Weber J.M.
        EMS provider perceptions on termination of resuscitation in a large, Urban EMS system.
        Prehosp Emerg Care. 2017; 21: 610-615https://doi.org/10.1080/10903127.2017.1317891
        • Shibahashi K.
        • Sugiyama K.
        • Hamabe Y.
        Pediatric out-of-hospital traumatic cardiopulmonary arrest after traffic accidents and termination of resuscitation.
        Ann Emerg Med. 2020; 75: 57-65https://doi.org/10.1016/j.annemergmed.2019.05.036
        • Meert K.L.
        • Thurston C.S.
        • Sarnaik A.P.
        End-of-life decision-making and satisfaction with care: parental perspectives.
        Pediatr Crit Care Med. 2000; 1: 179-185https://doi.org/10.1097/00130478-200010000-00017
        • Meert K.L.
        • Eggly S.
        • Pollack M.
        • et al.
        Parents' perspectives on physician-parent communication near the time of a child's death in the pediatric intensive care unit.
        Pediatr Crit Care Med. 2008; 9: 2-7https://doi.org/10.1097/01.PCC.0000298644.13882.88
        • Biarent D.
        • Bingham R.
        • Eich C.
        • Lopez-Herce J.
        • Maconochie I.
        • Rodriguez-Nunez A.
        • et al.
        European resuscitation council guidelines for resuscitation 2010 section 6. paediatric life support.
        Resuscitation. 2010; 81: 1364-1388