UMEM Educational Pearls

Category: Pediatrics

Title: Can kids survive traumatic cardiac arrest? (submitted by Nikki Alworth, MD)

Keywords: trauma, cardiac arrest, return of spontaneous circulation (PubMed Search)

Posted: 11/22/2013 by Mimi Lu, MD
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Pediatric traumatic arrest victims have a very low survival rate. Previous studies have shown that 21% achieve initial ROSC but only 0.3% survive hospital discharge with an intact neurologic status.

A recent retrospective study examined predictors of survival for pediatric traumatic out-of-hospital cardiac arrest. Of the 362 patients included in the study, none had spontaneous circulation upon arrival in ED. BLS was initiated by EMS in the field with a mean response time of 5.4 minutes and mean transport time of 10.2 minutes. The study compared MAP, cardiac rhythm, urine output, skin color of face/trunk, initial GCS and body temperature.

In this study, 9% of kids made it to discharge, 11 of which had good neurologic outcome and 23 with poor neurologic outcome. Predictors of survival were:
  • High or normal BP
  • Normal heart rate after ROSC
  • Sinus rhythm after ROSC
  • Urine output >1 ml/kg/hr
  • Noncyanotic skin color
  • GCS >7 on arrival
Limitations of study: Very few kids survive with good neurologic outcome, making it difficult to identify accurate predictors for this group as the sample size is too small. Further, this study didn't look at hypothermia or ECMO as a means to achieve improved outcome.

Reference: Predictors of survival and neurologic outcomes in children with traumatic out-of-hospital cardiac arrest during the early postresuscitative period. Lin YR, Wu HP, Chen WL, et al. Journal Trauma Acute Care Surg. Sept 2013:75(3);439-447.