Faculty Collaboration Database

A critical analysis of outcome for children sustaining cardiac arrest after blunt trauma. J Pediatr Surg 2002 Feb;37(2):180-4

Date

01/31/2002

Pubmed ID

11819195

DOI

10.1053/jpsu.2002.30251

Scopus ID

2-s2.0-0036154559 (requires institutional sign-in at Scopus site)   53 Citations

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.

Author List

Calkins CM, Bensard DD, Partrick DA, Karrer FM

Author

Casey Matthew Calkins MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Accidents, Traffic
Brain Injuries
Cardiopulmonary Resuscitation
Child
Child, Preschool
Emergency Service, Hospital
Female
Heart Arrest
Humans
Infant
Male
Spinal Cord Injuries
Survival Rate
Trauma Centers
Trauma Severity Indices
Wounds, Nonpenetrating