Related Experiment Video
Updated: Sep 27, 2026
Technical Refinement of a Bilateral Renal Ischemia-Reperfusion Mouse Model for Acute Kidney Injury Research
Published on: November 3, 2023
A critical analysis of outcome for children sustaining cardiac arrest after blunt trauma
Casey M Calkins1, Denis D Bensard, David A Partrick
1Denver, Colorado.
Insights
Pediatric cardiac arrest from blunt trauma has a very low survival rate, with most deaths due to head injuries. Cardiopulmonary resuscitation (CPR) in the field indicates a poor prognosis for children.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Pediatric Critical Care
Background:
- Injury is the primary cause of cardiac arrest in children over one year old.
- Survival to hospital discharge is rare for children requiring cardiopulmonary resuscitation (CPR) for any reason.
- Pediatric blunt trauma patients with cardiac arrest present a critical challenge in emergency care.
Purpose of the Study:
- To evaluate the survival outcomes of children experiencing cardiac arrest following blunt trauma.
- To identify factors influencing survival in pediatric blunt trauma patients requiring CPR.
- To assess the efficacy of emergency medical services interventions in pediatric trauma-induced cardiac arrest.
Main Methods:
- Retrospective review of a regional pediatric trauma center's registry (1997-2000).
- Inclusion criteria: children (<16 years) with cardiac arrest after blunt trauma, receiving CPR in the field or emergency department (ED).
- Data collected: demographics, survival to discharge, influencing factors, organ donation; survival probability calculated using TRISS analysis.
Main Results:
- Twenty-five children (mean age 3.3 years) with blunt trauma cardiac arrest were identified; calculated survival probability was 22.7%.
- Only 2 (8%) children survived to discharge; the majority of deaths (91%) resulted from brain or spinal cord injury.
- CPR was initiated in the field for 40% of patients, en route for 24%, and in the ED for 36%; survivors received initial CPR in the ED.
Conclusions:
- Cardiopulmonary resuscitation following pediatric blunt trauma is rarely successful, with survival rates significantly low.
- Intracranial injury is the predominant cause of death, rather than exsanguinating hemorrhage.
- Aggressive resuscitation is warranted, but CPR initiated in the field suggests a poor prognosis, potentially contraindicating prolonged resuscitation efforts.
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.
Related Concept Videos
01:26Flail Chest-II
Assessment:
1. Clinical Evaluation:
History:
01:21Cardiopulmonary Resuscitation I: Adult
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management