Related Experiment Video
Updated: Apr 6, 2026
Technical Refinement of a Bilateral Renal Ischemia-Reperfusion Mouse Model for Acute Kidney Injury Research
Published on: November 3, 2023
Outcome and risk factors in children after traumatic cardiac arrest and successful resuscitation
Jörn Zwingmann1, Rolf Lefering2,
1Department of Orthopedics and Trauma Surgery, Freiburg University Hospital, Freiburg, Germany.
Insights
Pediatric trauma patients receiving cardiopulmonary resuscitation (CPR) show better survival and neurological outcomes compared to adults. Emergency room resuscitation is particularly effective for children, suggesting revised guidelines may be warranted.
Area of Science:
- Trauma care
- Pediatric emergency medicine
- Cardiopulmonary resuscitation
Background:
- Analysis of prospective data from the TraumaRegister DGU(®) to assess survival and non-survival predictors in children with traumatic cardiorespiratory arrest.
- Comparison of resuscitation timing (preclinical, emergency room (ER), or both) and its impact on pediatric mortality and neurological outcomes.
Purpose of the Study:
- To derive survival rates and identify predictors of non-survival in children experiencing traumatic cardiorespiratory arrest.
- To evaluate the effectiveness of different resuscitation time points on mortality and neurological outcomes in pediatric trauma patients.
Main Methods:
- Analysis of the TraumaRegister DGU(®) database (1993-2013) focusing on pediatric patients (age ≤ 14 years) compared to adults.
- Application of univariate and multivariate analyses, including logistic regression, with mortality as the primary outcome variable.
Main Results:
- Children (19.4%) demonstrated significantly better outcomes (GOS 5+4) than adults (12.4%) following resuscitation (p=0.02).
- Emergency room (ER)-only resuscitation yielded better neurological outcomes in children (37.0%) compared to adults (19.6%) (p=0.046).
- Preclinical intubation, GCS 3, blood transfusion, and severe head injury (AIS ≥3, ISS) were significant predictors of mortality.
Conclusions:
- Cardiopulmonary resuscitation (CPR) in children with severe trauma appears more beneficial than current guidelines suggest, with better outcomes than in adults.
- Resuscitation within the ER is linked to superior neurological outcomes in pediatric trauma patients compared to preclinical or combined approaches.
- These findings support the potential revision of pediatric resuscitation algorithms based on improved outcomes observed in this study.
Introduction:
Prospective collected data of the TraumaRegister DGU(®) were analyzed to derive survival rates and predictors for non-survival in the children who had suffered traumatic cardiorespiratory arrest. Different time points of resuscitation efforts (only preclinical, in the emergency room (ER) or preclinical+ER) were analyzed in terms of mortality and neurological outcome.
Methods:
The database of the TraumaRegister DGU(®) comprising 122,742 patients from 1993 to 2013 was analyzed. The main focus of this survey was on the paediatric group defined by an age ≤ 14 years who could be compared to adults. Different statistical analysis (univariate and multivariate analysis, logistic regression) were performed with mortality as the target variable. Differences between the paedatric group and adults were analysed by Fisher's exact test.
Results:
Data after preclinical and/or ER resuscitation from 152 children and 1690 adults were analyzed. A good or moderate outcome (GOS 5+4) was found in 19.4% of the children's group compared to 12.4% of the adults (p=0.02). Analysis of the GOS 5+4 subgroups after preclinical resuscitation only revealed that these outcomes were achieved by 19.4% of the paediatric group and 13.2% of the adults (p=0.24), after ER-only resuscitation by 37.0% of the children and 19.6% of the adults (p=0.046), and after preclinical and ER resuscitation by only 10.9% of the children compared to 2.5% of the adults (p=0.006). Taking only survivors into account, 84.8% of the children and 62% of the adults had a GOS 4+5. The highest risk for mortality in the logistic regression model was associated with preclinical intubation, followed by GCS 3, blood transfusion and severe head injury with AIS ≥3 and ISS.
Conclusions:
CPR in children after severe trauma seems to yield a better outcome than in adults, and appears to be more justified than the current guidelines would imply. Resuscitation in the ER is associated with better neurological outcomes compared with resuscitation in a preclinical context or in both the preclinical phase and the ER. Our children's outcomes seem to be better than those in most of the earlier studies, and the data presented might support algorithms in the future especially for paediatric resuscitation.
Related Concept Videos
01:21Cardiopulmonary Resuscitation I: Adult
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:23Cardiopulmonary Resuscitation III: AED Use
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:26Acute Coronary Syndrome V: Nursing Management