A critical analysis of outcome for children sustaining cardiac arrest after blunt trauma

Presented at the 48th Annual International Congress of the British Association of Paediatric Surgeons, London, England, July 18-21, 2001.
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Abstract

Purpose: Injury is the leading cause of cardiac arrest in children older than 1 year. Previous findings suggest that children who require cardiopulmonary resuscitation (CPR) administered by paramedics for any reason rarely survive to hospital discharge. The authors evaluated the outcome of children sustaining cardiac arrest after blunt trauma in a Regional Pediatric Trauma Center. Methods: Children (age < 16) who underwent CPR in the field or in the emergency department (ED) after blunt trauma were identified from the trauma registry of a regional pediatric trauma center over a 3-year period (1997 to 2000). Patient demographics, rate of survival to discharge, factors influencing survival, and organ donation data were obtained from the trauma registry and medical record. Probability of survival (Ps) was calculated by TRISS analysis. Results: Twenty-five children were identified with a history of cardiac arrest after blunt injury (mean age; 3.3 years; range, 0.1 to 10; mean ISS, 30.7; range, 13-75; mean RTS, 1.58). Mean calculated Ps was 22.7%. However, only 2 (8%) survived. Death in the majority (91%) of the 23 patients who died occurred secondary to brain or spinal cord injury, and only 2 (9%) occurred as the result of exsanguinating hemorrhage. CPR was first performed in the field in 10 patients (40%), en route in 6 (24%), and in the ED in 9 (36%). Of the children who survived, both had vitals in the field, and CPR was administered initially in the ED. Mean length of ED resuscitation before death was 80 minutes. Of the children who died, organ donation occurred in only 3 (13%). The 2 survivors had no head injury and were discharged within 3 weeks of injury. Conclusions: Cardiopulmonary resuscitation after blunt injury in children rarely results in survival. The majority of deaths occur as a result of isolated intracranial injury and not exsanguinating hemorrhage. Although all children should receive aggressive resuscitation after injury, the need for CPR in the field portends a poor outcome. Furthermore, these data would suggest that prolonged or heroic efforts for children sustaining cardiac arrest in the field are not indicated. J Pediatr Surg 37:180-184. Copyright © 2002 by W.B. Saunders Company.

Section snippets

Patients

Children (age <16) who underwent CPR in the field or in the emergency department (ED) after blunt trauma were identified from the trauma registry of a regional pediatric trauma center over a 3-year period (1997 to 2000). Injured children are met on arrival to the pediatric emergency department by a pediatric surgery fellow or a general surgical resident (postgraduate year 4), a senior pediatric emergency medicine fellow (postgraduate year 4 or 5), and an attending pediatric emergency medicine

Patient demographics

There were 311 patients ≤ 16 years of age with an ISS greater than 15 consecutively evaluated by the trauma service over the 3-year period studied. During this time, 25 children (8%) were identified with a history of cardiac arrest after blunt injury. The mean age of the study population was 3.3 years (range, 0.1 to 10). Boys accounted for two thirds of the study population (16 boys, 9 girls).

Injury mechanism and severity

In this population of children sustaining cardiac arrest after blunt trauma, the largest percentage of

Discussion

Whereas the Sudden Infant Death Syndrome (SIDS) accounts for the majority of cardiopulmonary arrest in children less than 1 year of age,8 injury is the leading cause of cardiac arrest in children older than 1 year. Previous studies suggest that children who require CPR in the field after trauma, burns, or near drowning rarely survive to hospital discharge.3, 4, 5, 9 However, recently published data have suggested that pediatric survival rates after CPR performed after any traumatic insult are

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Address reprint requests to Casey M. Calkins, MD, Department of Surgery, University of Colorado Health Sciences Center, 4200 East Ninth Ave, Campus Box C-320, Denver, CO 80262.

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