Universally poor outcomes of pediatric traumatic arrest: a prospective case series and review of the literature

Abstract

Objective: Few data are available on traumatic cardiopulmonary arrest in children. Efforts at resuscitation typically result in heavy utilization of finite resources with little understanding of which characteristics, if any, may be associated with success. The objectives of this study were to describe the outcome of children in traumatic cardiac arrest and to identify patients for whom aggressive resuscitation may or may not be warranted.

Methods: Data were analyzed from a previous study of prehospital pediatric airway management in Los Angeles and Orange Counties, Calif, over a 33-month period. Patients included in this secondary analysis were younger than 13 years and found pulseless and apneic after having had an injury. Data sources included prospective, phone interviews with paramedics after transfer of care to the receiving facility, and chart review to determine outcome. Two main outcomes were assessed: survival and neurological function as measured by the Pediatric Cerebral Performance Category.

Results: The emergency medical services responded to 118 traumatic arrests during the study period. Of these victims, only 6 (5%) survived. Median Injury Severity Score was 25 with an interquartile range of 16 to 75. The survivors all were neurologically impaired with a median Pediatric Cerebral Performance Category of 5 (interquartile range, 4-5).

Conclusions: Children who had trauma resulting in cardiac arrest have universally poor outcomes, and survivors have severe neurological compromise. We are unable to identify a subset of patients for whom aggressive resuscitation is indicated. This is the largest prospective study of pediatric traumatic arrest to date.