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Cardiac arrest induced by blunt trauma in children
1Department of Critical Care, San Diego Children's Hospital, California 92123, USA.
Insights
Pediatric blunt trauma cardiac arrest is nearly always fatal, with most deaths occurring within 24 hours. Severe head injuries are the primary cause, leading to a notable rate of organ donation from these tragic cases.
Area of Science:
- Pediatric critical care
- Trauma surgery
- Emergency medicine
Background:
- Limited understanding of outcomes for children experiencing cardiac arrest after blunt trauma.
- Need to identify injury mechanisms, mortality rates, and organ donation potential in this vulnerable group.
Purpose of the Study:
- To investigate the outcomes of pediatric patients who suffered cardiac arrest following blunt trauma.
- To determine the common mechanisms of injury, mortality rates, and the feasibility of organ donation in this cohort.
Main Methods:
- Retrospective chart review of 10,979 pediatric trauma patients in San Diego County (1984-1996).
- Inclusion criteria: blunt trauma mechanism and pre-hospital or on-arrival cardiopulmonary resuscitation.
- Data collected on injury mechanism, severity, mortality, and organ donation rates.
Main Results:
- 65 children experienced cardiac arrest post-blunt trauma; 80% involved motor vehicle accidents.
- High average Injury Severity Score (50.3) and Abbreviated Injury Score for head/neck (5.9) indicated severe head trauma.
- Mortality was nearly uniform (99%) despite resuscitation, with 94% dying within 24 hours; one survivor had a vegetative state.
- Organ donation was achieved in 9% of cases.
Conclusions:
- Cardiac arrest following pediatric blunt trauma carries a rapidly fatal and near-universal outcome, even with resuscitation efforts.
- Severe head injuries are the predominant cause of death, making these patients a significant source for solid organ donation.
- The study highlights the critical need for trauma prevention and advanced care in pediatric blunt trauma cases.
Background:
There is incomplete knowledge regarding the outcome of children who suffer a cardiac arrest after blunt trauma. We sought to determine mechanisms of injury, mortality, and rate of organ donation in this population of children.
Methods:
Since 1984, all traumatically injured children in San Diego County, California, have been treated at San Diego Children's Hospital. This review encompasses 10,979 pediatric trauma patients evaluated from August 1, 1984 through September 30, 1996. All patients who did not meet the following two criteria were eliminated from the review: 1) a mechanism of blunt trauma, and 2) cardiopulmonary resuscitation performed by a trained medical provider prior to arriving or on arrival to the hospital. A chart review of this set of patients was undertaken to determine mechanism of injury, severity of injury, mortality, and rate of organ donation.
Results:
In this large metropolitan county, 65 children suffered cardiac arrest following blunt trauma. Accidents involving motor vehicles were the mechanisms responsible for 80% of these injuries. The average Injury Severity Score was 50.3. Mortality was largely related to severe head injury as manifested by a mean Abbreviated Injury Score for head and neck equal to 5.9. All but one of these patients died despite resuscitation. Ninety-four percent of these children died within the first 24 hours of injury. The single survivor was discharged in a vegetative state. Solid organs were obtained from 9% of the patients.
Conclusion:
The outcome from blunt cardiac arrest in children is rapidly and nearly uniformly fatal despite resuscitation. Because severe head injuries resulting in brain death are the leading cause of mortality, a significant percentage of organ donations are obtained from these patients.